To the Editor: The article by Martyres et al on drug-seeking behaviour by young heroin users,1 leading to the deaths of 202 people over 5 years, leads to an inescapable conclusion. Too often, the medical profession is part of the problem rather than the solution, and as a result young people die. Here is an issue where the admonition primum non nocere should be foremost in our practice.

After working with drug users and prescribing methadone for 22 years in a variety of settings, my experience is that drug users use drugs! Whether it is logical, safe or appropriate, or not, this group seeks drugs to modify or modulate their state of being. They often have serious medical and mental health issues, but have sadly decided on their preferred treatment without much knowledge of the diagnosis or of alternative interventions. They are often very skilled in obtaining drugs.

So, we must perform our role equally well. Doctors are not drug dealers. Our duty is not to promote or support intoxication, or even relaxed happiness if that increases the risk of misadventure. It is to promote and support health. It is difficult to see how a prescription for 50 benzodiazepines to a young person (or even an older person) can ever be construed as healthcare. To do it again next day, next week, on and on, is almost unbelievable, yet the data indicate that is exactly what is happening.1 Even publicans have rules prohibiting serving intoxicated patrons.

That one was “offering the customer what he asked for”, a common excuse for this sort of prescribing practice, would not be a suitable defence in the Coroner’s Court if insulin, digitalis, or even vitamin A, had been prescribed on request. But appeals to good practice and commonsense, along with current regulatory strategies, are apparently not sufficient to protect this vulnerable group. Kamien points out that data from the HIC could be used to provide immediate information to doctors about whether a patient is a “doctor shopper”.2 The data are already collected and could easily be made available if the will existed. Potential prescribers could at least gain accurate and timely information on which to base their decisions. There would be less excuse for “convenience store” prescribing, and more chance of ethical behaviour. At present these data remain largely useless in preventing avoidable deaths. But, surely, learning nothing from the deaths of 202 young Australians is not an option?

To the Editor: I write to share my concerns about the “doctor shoppers” in our community.1 The large medical group in which I practice has long been tormented by the demands of a constant stream of drug addicts, and I feel that we have now lost a very useful tool for dealing with these patients.

I refer to the loss of access to the “Doctor Shopping Hotline”. This has resulted in increased aggravation for both staff and doctors. The problem is compounded by our practice being open at weekends and public holidays, when these patients arrive with the familiar story of not being able to get their benzodiazepines and opiates because their own doctors are not available.

The Health Insurance Commission recently notified me about a patient who had attended our surgery, and many others, during a 3-month period last year. During this time, he saw more than 30 doctors and was prescribed more than 300 Pharmaceutical Benefits Scheme (PBS) items (6000 benzodiazepines and more than 2000 opiates [Panadeine Forte]).

I strongly feel that the hotline should be reinstated — for the benefit of the doctors and the patients, and to help reduce a totally unwarranted drain on the PBS.

In reply: I note the concerns expressed by Hart in relation to the discontinuation of the Doctor Shopping Hotline, and his call for the reinstatement of such a service.

The Doctor Shopping Project, which was funded to the end of June 2002, focused on a limited selection of nervous system medications. It has been replaced by the Prescription Shopping Project, which is much broader in scope, as it encompasses all medicines on the Pharmaceutical Benefits Scheme (PBS). The new project aims to reduce the number of patients obtaining PBS medicines in excess of therapeutic need, and provides the opportunity for more informed prescribing across all categories of PBS medicine.

The Health Insurance Commission (HIC) recognises the value of an information service for medical practitioners under the Prescription Shopping Project. An independent researcher has been engaged to explore the reactions and attitudes of medical practitioners and consumers to implementing such an information service. The research also aims to gain insight into medical practitioners’ intentions of using such a service, and their expectations of the scope and delivery of the service. Findings were presented to the HIC in early July 2004. The HIC will now convene a forum of relevant peak bodies to consider the scope and delivery of an information service in light of the findings.

The HIC looks forward to working with the profession to establish an information service for medical practitioners under the Prescription Shopping Project.