Ethics, Law, and Medical Practice

The PBS at present authorises pharmacists to dispense a cheaper generic alternative for some drugs prescribed by their trade name unless the doctor indicates on the prescription that generic substitution is not permitted.

Patients commit criminal offences by forging or altering prescriptions or by attending several practitioners to obtain drugs for themselves or to sell to others. In Victoria, patients are obliged to inform doctors if they have received drugs of dependence from other doctors in the previous eight weeks.

The management of patients with chronic pain is one of the most difficult clinical situations facing doctors. The use of opioid analgesics can be very valuable for pain relief but carries a very high risk of addiction in all patients. It is the professional responsibility of the doctor to minimise this risk. Attention is drawn also to two properties of pethidine which make it especially inappropriate in the management of chronic pain. First, its central effects create a desire for readministration, making it very highly addictive. Second, after a few days of regular use, the active metabolite norpethidine will accumulate, and may cause neurological effects including confusion, twitching and seizures.³

1 Lyndon R, Russell J. "'Benzodiazepine use in a rural general practice population.'" Aust NZ J of Psychiatry 1988; 22: 293-8.

2 NHMRC Guidelines for the prevention and management of benzodiazepine dependencies. Monograph Series No. 3 1991. Canberra: AGPS.

3 Guidelines for the management of patients Complaining of severe, recurrent or chronic pain. Issued by the South Australian Branch of the Australian Medical Association and the South Australian Medical Board. 1995.

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