Online prescribing has been a topic of both great interest and concern within the prescribing community for some time. It came to the forefront of mainstream healthcare news recently when a 41-year old women died after obtaining an opioid prescription online (Kirkland, 2019).
The NHS website clearly states that ‘medication should only be taken under the supervision of a healthcare professional. Their guidance on whether a medication is suitable for you, the dosage, possible side effects, and any harmful interactions with other medications is crucial’ (NHS Choices, 2018). In the case of this patient, her GP had begun prescribing opiates in 2008 to relieve back pain. He subsequently tried to wean her off over time – unfortunately, because of the availability of the medication via an online prescriber, the patient was able to purchase drugs prescribed by doctors through UK online pharmacy websites, as well as a smaller dosage (to wean off) from her regular GP.
The coroner noted at the inquest that there had been ‘regulatory gaps’ that allowed this fatal error to transpire. The inquest further highlighted that there is no single database that allows a prescribing clinician to identify what has already been prescribed to a patient. For opiate drugs, such as codeine, there is no analysis of how many drugs are being prescribed outside of the NHS (Kirkland, 2019). New guidelines were published by the General Pharmaceutical Council (2019) in April to avoid an event such as this unfolding. They stated that in cases of prescribing high-risk medications, such as opiates, pharmacies should consult with the patient's family doctor, prior to medication being prescribed and dispensed. However, these are only stated as guidelines rather than a code of conduct. More still needs to be done in order to ensure these practices are followed, otherwise outcomes similar to this woman's death could become a more regular occurrence.
As we now enter 2020, the Journal of Prescribing Practice (JPrP) will continue to bring in-depth content direct to the prescribing practitioner community. With the recent general election results now known, we wait with bated breath to see how our community will be affected (BBC, 2019). Due to the general election, there will be no Updates page this month, as NICE were unable to publish up-to-date guidelines during the election campaign. This will continue as normal in February.
This year we are extending our Drug Breakdown page to help you grow your Continued Personal Development (CPD) with the help of Sharon Rees, Associate Professor of Therapeutics and Prescribing. By reading her drug series of the month (page 6), alongside the suggested additional reading, you can submit answers to the questions posed and earn a one-hour CPD certificate month-on-month.
I wish you a very happy new year and look forward to continuing to work with the prescribing community.