What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non-medical use between 2010 and 2016

Shann Hulme, Caitlin Elizabeth Hughes, Suzanne Nielsen

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Introduction and Aims: Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. Design and Methods: Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. Results: Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63–640.11) and pharmacists (AOR 85.59, 95% CI 5.08–1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80–97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01–0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50–157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24–20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1.52–41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. Discussion and Conclusions: Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs.

Original languageEnglish
Pages (from-to)366-376
Number of pages11
JournalDrug and Alcohol Review
Volume38
Issue number4
DOIs
Publication statusPublished - May 2019

Keywords

  • health practitioners’ misconduct
  • overprescribing
  • pharmaceutical diversion
  • prescription drug misuse
  • supply

Cite this

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title = "What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non-medical use between 2010 and 2016",
abstract = "Introduction and Aims: Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. Design and Methods: Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. Results: Cases involving inappropriate prescribing/supply (73{\%}) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95{\%} confidence interval [CI] 3.63–640.11) and pharmacists (AOR 85.59, 95{\%} CI 5.08–1443.05) and HPs over 50 years (AOR 16.54, 95{\%} CI 2.80–97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95{\%} CI 0.01–0.57). Cases involving misappropriation (31{\%}) had greater odds of involving nurses (AOR 19.86, 95{\%} CI 2.50–157.93), HPs under 40 years (AOR 5.08, 95{\%} CI 1.24–20.90) and being attributed to individual circumstances (AOR 7.96, 95{\%} CI 1.52–41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. Discussion and Conclusions: Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs.",
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What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non-medical use between 2010 and 2016. / Hulme, Shann; Hughes, Caitlin Elizabeth; Nielsen, Suzanne.

In: Drug and Alcohol Review, Vol. 38, No. 4, 05.2019, p. 366-376.

Research output: Contribution to journalArticleResearchpeer-review

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