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
Increasing quantities of pharmaceutical drugs are used non‐medically around the world, including in Australia, resulting in rising harms. The authors examined the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia.
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.
There were a total of 117 cases identified from 2010 to 2016, with over half (62%, n = 72) heard between 2014 and 2016. The cases primarily involved doctors (52%, n = 61), followed by pharmacists (32%, n = 37) and nurses (15%, n = 18). Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors and pharmacists and HPs over 50 years and lower odds of being attributed to individual circumstances. Cases involving misappropriation (31%) had greater odds of involving nurses, HPs under 40 years and being attributed to individual circumstances. 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.
Misappropriation by HPs from the workplace was typically smaller scale and attributed to the complex needs of the HP, including health and substance use problems.
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.