Methadone is meant to save lives by preventing drug abuse. Other prescription drugs are supposed to improve physical and mental health. So when the Western Australian Coroner informed me in writing that an otherwise healthy 40 year old woman died from an overdose of Methadone, prescribed to prevent her continuing to abuse prescription drugs, it was obvious something had gone terribly wrong. And when he added that ‘in recent times this office has become aware of a number of cases of methadone overdose’, it became obvious something is going terribly wrong far too often.
Prior to her death in September 2010 the mother of seven had a long history of abusing a variety of prescription drugs including Valium, Stillnox (a sleeping pill) and ‘over the counter codeine preparations’. Her autopsy revealed that ‘methadone was found at fatal levels and promethazine (commonly found in fenurgen) was found at toxic levels’. The Coroner concluded the doctor treating her appeared ‘to have acted in a very professional manner and communicated with her regular pharmacist with a view to limiting her abuse of these medications. Ms X was put on the methadone program with a view to harm reduction and efforts were made to limit her access to drugs through her pharmacy’.
It really didn’t help that her doctor and pharmacist had acted professionally. The fundamental problem was that she and other members of her family visited many doctors and many pharmacists, via whom they regularly received an array of taxpayer subsidised, abuse-able, prescription drugs. According to her brother in law, Geoff, family members would visit different doctors, fake symptoms and get the desired diagnosis and prescription. They would then drive from pharmacist to pharmacist and get the scripts filled.
As responsible and competent as each of these individual doctors and pharmacists may have been, they had no way of knowing who else was prescribing or dispensing abuse-able drugs to these motivated doctor and pharmacy shoppers. Without this information it must be near impossible for time pressured clinicians to pick who is faking it and who is really ill. This is especially true for the diagnosis of psychiatric disorders and pain management, where there are few if any objective ways of confirming disease.
The tragedy of this mother’s death is not just that she left seven children, but also that it was entirely predictable and easily avoidable. Over a year before the woman died, Geoff began a one man crusade to alert the police, the Medicare Fraud Squad, doctors and pharmacists of the frequent doctor and pharmacy shopping by members of his family. He was motivated only by their welfare but despite his determined and persistent efforts, his worst fears became reality. The truth is, in the absence of a system of collating information about the prescriptions of abuse-able drugs written and dispensed, nothing was, or arguably could have been, done.
Without government action this family’s tragic story will be repeated. There will be more suffering, more deaths and more children without parents because the attractions of abusing prescription drugs are considerable. Firstly they are cheap, usually subsidised by taxpayers through the Pharmaceutical Benefits Scheme. Secondly the fact that they are used for therapeutic purposes can lull abusers into the false belief that the drugs are inherently safe. Thirdly abusing prescription drugs doesn’t carry the same legal risks as illicit drugs, despite the fact they are often more physically dangerous. Drug abusers know they may be able to explain to the police’s satisfaction why they have a stash of prescription Stillnox, Valium or Dexamphetamine. However, they also know they have absolutely no chance of claiming that a stash of cannabis is on hand for legal therapeutic purposes.
The good news is there is a very simple solution. Currently there are some isolated measures designed to help doctors and pharmacists suspicious of doctor shoppers but clearly they are inadequate. What is needed is a comprehensive, easy to use, ‘real time’ system of sharing information before prescriptions are dispensed. The Commonwealth and State governments may need to co-operate and remove privacy restrictions so that pharmacists can share information about what abuse-able drugs have been dispensed to individuals presenting prescription in their pharmacies. This change and a modest investment by government in the software needed to allow the ‘real time’ sharing of information between pharmacists, will shut off the pipeline of abuse-able prescription drugs that is fuelling this misery.
No patient with a genuine therapeutic need will be denied medications. Only patients who are continuously requesting abuse-able prescription drugs faster than the recommended dosage would be denied. This solution will save lives as well as taxpayers’ money. Millions of taxpayers’ dollars that currently subsidise pharmaceutical abuse and addiction via the Pharmaceutical Benefits Scheme can be redirected to therapies that help address real disease and real need.
I first called for this reform in early 2009. Lenette Mullen, President of the Pharmacy Guild of Western Australia has been calling for this type of reform for even longer. This week the Western Australian President of the Australian Medical Association, Doctor David Mountain, also made a similar call. He identified that professional doctor shoppers motivated by money, rather than addiction, are supplying a flourishing black market. Now the Western Australian Coroner, Alistair Hope, has identified that ‘other similar cases…highlight the need for there to be a central register for all medications which would record all scripts (for abuse-able prescription drugs)’ the momentum for change should be irresistible.
In summary, a mother of seven died from an overdose of a prescription drug prescribed to prevent her abusing other prescription drugs and according to the Coroner this is not an isolated case. That is absurd and tragic, particularly when there is a very simple solution to this large and growing problem. Now that the AMA, the Pharmacy Guild and the Coroner have joined the call for simple commonsense reform, surely governments must act.