Online Prescriptions or Real Life Addictions?
With the rules around online prescribing set to be strengthened, we consider why these changes have come about, and what it might mean for patients and prescribers.
With GP appointment waiting times increasing, patients are seeking quick and alternative means of accessing their medicine, so it's no surprise that the use of online pharmacies has increased astronomically; in the last decade, the number of internet pharmacies has quadrupled.
However, that could all be set to change as the General Pharmaceutical Council (GPhC), which regulates the sector, plans to strengthen the rules governing online prescribing.
Just over a month ago, the GPhC published a discussion paper (Making sure patients and the public obtain medicines and other pharmacy services safely online). Open to comment until 21 August 2018, the proposed changes will mean that online pharmacies would be obliged to put in place new safeguards to protect people who want to obtain certain medicines online, including:
Antibiotics: these should usually only be prescribed and supplied if physical examination or diagnostic testing shows that they are clinically appropriate and thought has been given to stewardship guidelines (i.e. to slow the emergence of resistance);
Opiates (such as codeine and tramadol): should only be prescribed and supplied if the patient has given consent for the prescriber to contact the patient's GP and the GP has confirmed to the prescriber that the prescription is appropriate for the patient (and appropriate monitoring is in place);
Non-surgical cosmetic medicinal products (such as Botox): should only be prescribed and supplied after the prescriber has carried out a physical examination of the patient.
It seems that both public and expert opinion have some part to play in the proposed changes.
Sarah Wollaston MP (doctor and chairwoman of the Commons Health Select Committee) has recently been quoted as saying that prescribing medicines such as opioids through online pharmacies was "appalling… that is the way to end up with people having addiction. It shouldn’t be allowed".
America's opioid crisis is well documented, referred to as the "worst drug crisis in American History" and there's concern that the UK is following suit. In 2017, nearly 24 million opioids were prescribed in the UK– equivalent to around 2,700 packs per hour, and latest figures show the number of people dying from opioid-related drug misuse has reached a record high in England and Wales.
The inappropriate prescription of antibiotics has dominated the headlines for a while now ("Antibiotic madness: A fifth of prescriptions given out by GPs are to patients who do not need them": Mail Online), with the concern being that it results in the development of resistant strains of bacteria – the 'superbugs'. Concerns over Botox have caught the attention of both the GMC and the NMC in the past few years, so perhaps it's no surprise that the GPhC has felt the need to tackle these issues too.
What will be the impact?
Well, any changes to the rules will take a while to implement – at the moment, the GPhC is still in consultation on its proposals- but, if, and when, the rules do change, patients can expect to see a more stringent approach taken to their prescribing.
Online prescribers will need to be extremely careful in their approach, documenting all their decisions accurately and appropriately, and ensuring that the correct checks and processes are in place – and Insurers will want to make sure that this is the case.
Whilst technology might have advanced rapidly over the past ten years, and whilst the future remains bright for its use in medicine, there is still value in the face to face consultation. It might well be worth remembering, in the words of the Hippocratic Oath, the part that warmth, sympathy and understanding has to play too.