Doctors, drugs of dependence and discipline: new review out

The review’s lead author says the low number probably reflects that discipline is a last resort, which is fitting since drug dependence should be treated as a health issue rather than a crime.

The review, which covers the years 1997-2016, is out today in the New Zealand Medical Journal. It also found that cases more commonly come to light via reporting from pharmacists (24 percent), rather than medical colleagues, who only reported four (16 percent) of the cases.

Lead author Dr Katharine Wallis, from the University of Auckland Faculty of Medical and Health Sciences, says it’s not surprising that the number of disciplinary decisions is low because, ideally, the majority of drug dependence cases in health professionals would be handled by The Medical Council’s Health Committee, protecting both the public and the doctors’ safety.

“Drug dependence is a health issue rather than a crime,” says Dr Wallis, a senior lecturer in the School of Population Health and practising GP.

“The very low number of disciplinary cases involving drugs of dependence suggests that discipline is used as a last resort, which is the right approach.”

The review, co-authored by medical student Susie Middleton, analysed publically available decisions and found only 26 of the total 236 disciplinary cases against doctors in the 20-year period involved inappropriate prescribing of drugs of dependence. It was not clear that the drugs were for self-use, although it is likely the majority were, says Dr Wallis. Most cases also involved other behaviour, such as sexual relations with patients and forging a colleague’s signature.

Disciplined doctors were mostly men (19, or 76 percent), working in general practice (19, or 76 percent) and older (averaging 24 years in practice). Discipline often spelled the end of their careers.

Dr Wallis says the fact that pharmacists rather than medical colleagues were more likely to flag suspected problems with authorities may be because the pharmacists were the ones filling the prescriptions, while medical colleagues were not aware “perhaps because the doctors kept the issue hidden, or perhaps because they had become isolated in practice, or because colleagues were unwilling to report”.

Her message to doctors: “By reporting your colleague, you can be helping them rather than harming them. If you think you have an issue with drug dependence, please seek help.”