Drug Dealing

By Jim McVeagh 22/09/2009

In the Herald today:

Dr Penelope Briscoe, dean of the faculty of pain medicine at Australia and New Zealand College of Anaesthetists (ANZCA), says reform is needed to curb the illicit use and sale of powerful prescription medicines.

I view statements like this with some trepidation. I don’t know how it is in Australia, but, in New Zealand, all of the narcotic drugs are heavily controlled. It is always possible to circumvent these controls, of course, but adding further controls will just make it harder for doctors to prescribe these medicines, to the detriment of those who genuinely need the drugs.

I have a special interest in the management of chronic pain syndromes which means, in our group practice, most patients with chronic pain gravitate to me (the majority of doctors do not like these patients partly because they feel “nothing can be done” – not true– and partly because they take a lot of time –very true!). Restrictions on what drugs I can prescribe and how often I can prescribe them would have serious repercussions for my patients. Sending them to pain clinics is also not an option, as most pain clinics are significantly overloaded.

Contrary to the implication in the article that doctors are a bit gullible about narcotics, most doctors are still excessively cautious and tend to under-prescribe them. They do not use the more powerful drugs when they should and they do not use sufficient doses when they do. This has improved substantially over the past decade, but any attempt at this juncture to place further restrictions on these drugs will have GPs using paediatric doses on adults again before you can say “over-cautious”.

There is also no necessity for further regulation. The vast majority of oxycodone and morphine abuse in New Zealand involves drugs attained through criminal means (theft of stock or prescription pads and illegal importation) rather than the over-prescription of these drugs by gung-ho doctors. GPs usually make notoriously poor drug dealers, anyway, often maintaining a fabrication of integrity and ethics that leads to their discovery and arrest. Wealthy celebrities often find access to these poor lost medical souls and access their drugs through this semi-respectable means. Presumably actors involved in drug abuse have the same poor self -respect as the doctors who supply them, so this seems like a marriage made, most assuredly, in hell.

But if we take our regulatory cues from dubious doctors and drug-crazed celebrities then we deserve the chaos and intended consequences that befall us.