Inappropriate dispensing of fentanyl transdermal patches

The NSW Ministry of Health’s Pharmaceutical Regulatory Unit has reported that large numbers of forged prescriptions for fentanyl transdermal patches have been presented and dispensed at some pharmacies. This is of serious concern because the risks associated with the abuse and misuse of fentanyl patches, such as the injection of fentanyl extracted from the patches, include overdose and death.

Pharmacists have a role as “gatekeepers” to protect the community

Pharmacists have a key role to minimise risks of abuse and diversion of prescription medicines by exercising responsible professional judgement. Prescriptions should be routinely scrutinised by:

• Reviewing dispensing history together with prescriptions presented for evidence of excessive consumption
• Reviewing dispensing history together with prescriptions presented for consideration of a combination of drugs liable to abuse (e.g. opioids with benzodiazepines and anabolic steroids with tamoxifen and clomiphene)
• Being alert to patients obtaining prescriptions from multiple doctors
• Being alert to patients from out of the area, presenting prescriptions purportedly issued by doctors from out of the area
• Being alert that prescriptions are not always but often for higher strengths where there has been no evidence of the dose being titrated up
• Being alert that it would be unusual for a person presenting these prescriptions not to have a history of medication for break through pain
• Carefully checking prescriptions to detect possible forgeries

Pharmacists are advised:

• Contact and discuss with the prescriber writing “private” prescriptions for drugs liable to abuse, particularly where the quantity requested is in excess of the maximum PBS quantity
• Contact the prescriber to confirm the validity of prescriptions if there are any doubts or concerns (in addition to the statutory requirements to confirm the validity of Schedule 8 drugs when the patient and/or the prescriber is unknown).
• Independently verify a prescriber, especially if the purported prescriber has contacted the pharmacy by telephone to authorise the dispensing of a drug liable to abuse
• Be wary of prescriptions for drugs known to be abused being presented by persons claiming to be agents for a person or a group of persons.
• Contact prescribers when it is found that patients are obtaining prescriptions for drugs liable to abuse from multiple prescribers.
• Be wary if there is a sudden influx of these prescriptions as it may be that your pharmacy is seen as a soft target.

Regulation

The Pharmaceutical Regulatory Unit administers the Poisons and Therapeutic Goods legislation in NSW and promotes the safe use of medicines by publishing contemporary guidance materials for pharmacists, doctors, dentists and nurse practitioners. Action which may be taken against serious breaches of the legislation may include:

• Prosecution
• Withdrawal of drug authorities
• Referral of criminal activity to police
• Referral of complaints of professional misconduct to the Health Care Complaints Commission and/or the appropriate Health Professional Council.

More information

NSW Health

Telephone: Duty Pharmaceutical Officer: (02) 9391 9944

Email: pharmserv@doh.health.nsw.gov.au