This article from the Medicines and Poisons Regulation Branch of the Victorian Department of Health was published in the November 2023 edition of Vetboard Victoria's newsletter. Content was current at the time of publication but there may have been changes since then, as rules, standards and professional and community expectations change over time. Readers are also referred to our Guidelines for appropriate standards of veterinary practice and veterinary facilities.
Practice alert and case study: avoid being deceived by drug-seeking clients
Introduction
The Victorian Department of Health has received numerous notifications about forged veterinary prescriptions being presented to pharmacies, usually for Schedule 4 and Schedule 8 drugs of dependence, as well as other medicines subject to misuse.
Many of the fraudulent prescriptions are almost identical to the original prescriptions issued, and in some cases the veterinarian had difficulty differentiating which ones were fraudulent without checking their records.
Some fraudulent prescriptions are being presented as hard copy computer-generated paper prescriptions, while others are being presented on the offender‘s mobile phone, with the offender claiming that the veterinarian had emailed the prescription (showing a gmail / hotmail email address purportedly linked to the veterinary practice rather than a work email
Warning signs
Veterinarians should recognise some of the warning signs that may indicate a drug-seeking client:
- A new client specifically requesting medication that is at high risk of being diverted or misused
- A client requesting large quantities and/or repeats of medication that is at high risk of being diverted or misused
- A client who presents mostly via video/telephone consultations and requests medications subject to misuse
- A client who disagrees with a veterinarian’s recommendation for treatment and presents an elaborate reason why their animal may require a different course of treatment involving drugs of dependence
- A client who continuously requests prescriptions early and/or claims to have lost/misplaced the medicine or requires extra supply as they have plans to travel.
Example case study
A client attended a veterinary practice requesting diazepam and trazadone for their dog. They claimed to live in a regional area and travel long distances by car to work with their dog, which would experience anxiety and motion sickness.
The client stated that fluoxetine had previously been ineffective. Believing the case to be genuine, the veterinarian wrote prescriptions for diazepam and trazadone with several repeats. Months later, the client called to request further prescriptions via teleconsult. The client provided what appeared to be a reasonable excuse for requiring an early prescription. The veterinarian subsequently obliged and issued a further prescription with repeats.
Over a period of months, the veterinarian continued to have several remote consults via video or telephone, during which further prescriptions were issued.
Eventually, the veterinarian became suspicious and refused to continue to issue prescriptions and asked the client to find a new veterinary clinic. The veterinarian noted on the patient’s clinical records that they believed the owner was drug-seeking and alerted the practice manager to the issue. However, the veterinarian failed to notify the Department and Victoria Police of these concerns.
Approximately six months later, the client attended a pharmacy with his dog and presented a computer generated paper prescription for diazepam and clonidine.
The pharmacist identified that the prescription for diazepam did not comply with the legal requirements for prescribing a Schedule 4 drug of dependence specifically, that it did not contain any handwritten details of the prescription particulars.
Being unfamiliar with the prescriber and unable to verify its authenticity due to the client presenting late in the evening, the pharmacist retained a copy of the prescription and asked the client to come back the next day to collect the medicine.
The next day, the pharmacist contacted the veterinarian in order to verify the prescription and was told it was fraudulent and that the veterinarian had not issued a prescription in over 10 months.
Complying with their legal obligations, the pharmacist notified both Victoria Police and the Department about the forged scripts, which resulted in a police investigation into the client’s conduct.
Your legislative and professional obligations
Take these steps to ensure you are fulfilling your legislative and professional requirements:
- Familiarise yourself with the required components for computer generated prescriptions, i.e., paper prescriptions printed using computer software rather than handwritten prescriptions.
- Understand the meaning of the term “drug of dependence”.
- Understand the requirement in the Drugs, Poisons and Controlled Substances Regulations 2017 for a practitioner to take “all reasonable steps”.
- Discuss and formulate a policy within your clinic for remote prescribing to ensure that prescribers are adhering to legislative and professional standards.
- Know when you are required to notify the health department and/or police of conduct
- Familiarise yourself with the following documents, which can be accessed on the Department’s website and which contain information that is intended to assist a veterinary practitioner to prescribe safely and lawfully in Victoria:
Questions?
You can lodge an enquiry with the Medicines & Poisons Regulation Branch of the Department of Health via its enquiry form: https://forms.business.gov.au/smartforms/landing.htm?formCode=mpr-enquiry
Relevant guidelines