Medicine Misuse

Policy

For more information, see bpac: Unintentional Misuse of Prescription Medicines, HealthPathways: Drug Seekers, and Principles for Quality and Safe Prescribing Practice.

Medicine misuse refers to using medicines in a manner or dose other than prescribed. This includes increasing the dose or frequency of use or continuing a medicine when it is no longer required.

Controlled or restricted medicines are only prescribed where there is sound clinical reason for doing so.

We take steps to make sure that prescribed medications are used appropriately:

• Prescribers check the patient's prescription history and follow any treatment plans documented in patient notes.

  Prescriber refers to any authorised prescriber (including designated prescribers or delegated prescribers), as determined by the Medicines Act 1981.

  This could include medical practitioners, authorised nurses, nurse practitioners, and pharmacist prescribers.

  Source: Principles for quality and safe prescribing practice

• Prescribers can refuse to prescribe restricted or controlled drugs if they are not fully satisfied that the medication is appropriate.
• We regularly review repeat prescriptions to make sure they are still beneficial and appropriate for the patient.
• Casual patients are not normally prescribed controlled drugs and are referred back to their usual prescriber.
• We don't prescribe more than 1 to 3 days' supply to a new or unfamiliar patient without comprehensively assessing the rationale and protocol for treatment.

See also Controlled Drug Stock and Controlled Drug Prescriptions

Detecting medicine misuse

Refer to bpac: Identifying Medicine Misuse.

If a patient is misusing medicines:

• Take appropriate steps to confirm medication misuse.

  Steps that can be taken to confirm medication misuse may include:

  • medicine counts
  • checking electronic databases of prescribing and dispensing history
  • formal treatment contract – specifying that a patient agrees only receive prescriptions from one prescriber and pharmacy
  • direct communication with the dispensing pharmacist
  • urinary drug testing.

  Source: bpac^nz: Unintentional misuse of prescription medicines

• Deprescribe misused medications with gradual withdrawal or dose reduction.
• Set individualised and functional goals for treatment, and document this in patient notes.
• Monitor and review patient progress.

Substance use disorders

Medications misuse and substance use dependency are different. Section 24 of the Misuse of Drugs Act 1975 restricts the supply of controlled drugs to patients dependent on them.

If there is concern that the patient is looking for medicines of misuse from other sources, a restriction notice may be applied. Restriction notices are issued when there is clear evidence of medicine misuse. Restriction notices are most effective when the patient has agreed to abide by the conditions.

See Ministry of Health | Manatū Hauora: Drug Abuse Containment.

Patients may be dismissed from the practice if they are misusing their medication, not taking the prescribed medication, or taking additional illegal or illicit drugs. We refer or direct dismissed patients to appropriate alternative services.