Self prescribing and prescribing for your own family are not generally recommended. Most cases in the public domain involve fraud or opioids, with ethical conflicts being dealt with by other mechanisms. Multiple international studies have shown that self prescribing of opioids is most commonly identified as an issue in primary care. As there is evidence that a pattern of self prescribing behaviour is established early in doctors professional lives advice, education on this issue is probably best targeted early. A particular issue is that junior doctors may not have a patient relationship with a primary care physician. Individual states and employers deal with the situation differently, so the act itself can be a disciplinary offense in some jurisdictions. In other jurisdictions there may be an implicit duty to prescribe in emergency exceptional situations where there are no reasonable alternatives.
The situation in the U.K.
While doctors registered with the General Medical Council (GMC) may prescribe medicines to anyone, there are some finer points to this statutory right. Your prescribing must be responsible and able to be seen to be reasonable by others, including the GMC. Provisional or limited registration only allows the prescription of medicines in line with the supervisory conditions of the registration.
Present GMC guidance, published in 2013), is stricter than previous guidance from 1998, 2006 and 2008 (see boxes).
Pharmacists and hospital pharmacies will tend to have their own rules for handling the situation. Pharmacists may be very cooperative in an emergency situation (they actually have rights of supply themselves in emergencies but are far more likely to ask you to write your own script if the situation is explained). Any registered doctor can write a private prescription, but of course the pharmacist will be expected to take steps to verify it is legitimate. This may be trivial if you are already known to the pharmacist, through say your private practice and using your private practice letter head, but may be challenging otherwise.
Catches as defined by GMC misconduct hearings
- Writing an NHS script for a non-NHS patient (relative)
- Writing a request for supply with the intention of supply to an individual (relative overseas)
- Inadequate assessment
- Writing a private script for a patient you have not assessed appropriately (relative overseas)
- Situations where loss of objectivity would be obvious to peers
- eg narcotics
The situation in the U.S.A
The AMA has an opinion which is likely to be endorsed by State regulators.
There is more known about the current extent of this practice in the USA and the ethics have been analysed, particularly around the issue of inadequate assessment.
The situation in Canada
The CMA has guidance which is re-enforced by State regulators. It is a common issue.
The situation in Australia
Victorian government regulations prohibit doctors from self prescribing prescription only drugs. However the other federal states do not. This has allowed an analysis of the impact of such legislation, suggesting it may be counter productive.
The situation in N.Z.
- ↑ Cadman M, Bell J. Doctors detected self-administering opioids in New South Wales, 1985-1994: characteristics and outcomes. The Medical journal of Australia. 1998 Oct 19; 169(8):419-21.
- ↑ Goldenbaum DM, Christopher M, Gallagher RM, Fishman S, Payne R, Joranson D, Edmondson D, McKee J, Thexton A. Physicians charged with opioid analgesic-prescribing offenses. Pain medicine (Malden, Mass.). 2008 Sep; 9(6):737-47.(Link to article – subscription may be required.)
- ↑ Hem E, Stokke G, Tyssen R, Grønvold NT, Vaglum P, Ekeberg Ø. Self-prescribing among young Norwegian doctors: a nine-year follow-up study of a nationwide sample. BMC medicine. 2005; 3:16.(Epub) (Link to article – subscription may be required.)
- ↑ Kay MP, Mitchell GK, Del Mar CB. Doctors do not adequately look after their own physical health. The Medical journal of Australia. 2004 Oct 4; 181(7):368-70.
- ↑ GMC Good Medical Practice]
- ↑ GMC Prescribing guidance: Need and objectivity 2013
- ↑ Walter JK, Lang CW, Ross LF. When physicians forego the doctor-patient relationship, should they elect to self-prescribe or curbside? An empirical and ethical analysis. Journal of medical ethics. 2010 Jan; 36(1):19-23.(Link to article – subscription may be required.)
- ↑ Kay M, Del Mar CB, Mitchell G. Does legislation reduce harm to doctors who prescribe for themselves? Australian family physician. 2005 Jan-Feb; 34(1-2):94-6.link to article