Public Consultation on Proposed Measures to Monitor Errant Prescribing of Benzodiazepines

Ministry of Health - Corporate Communications Division

Consultation Period: 07 Dec 2011 - 07 Jan 2012

Status: Closed

Summary

As part of the Ministry of Health’s (MOH) efforts to better monitor prescribing patterns of benzodiazepines and to prevent the inappropriate use of addictive drugs, MOH is proposing to make it mandatory for all doctors to enter dispensing details for all benzodiazepines into a web-based Central Drug Prescribing Registry (CDPR) system. Besides enabling MOH to monitor prescribing patterns for these drugs, the system will allow doctors to identify “doctor-hopping” behaviours of potential drug abusers who may visit different clinics to get their drugs.

Detailed Description

PUBLIC CONSULTATION PAPER

ON PROPOSED MEASURES TO MONITOR ERRANT PRESCRIBING OF BENZODIAZEPINES

EXECUTIVE SUMMARY

1 Benzodiazepines are drugs commonly prescribed for treating insomnia, anxiety and other medical conditions. However, long term inappropriate usage may result in physical dependence on the drug, and potentially serious ill-effects.

2 MOH proposes to make it mandatory for all doctors to enter dispensing details for all benzodiazepines into the Central Drug Prescribing Registry (CDPR) system. This will assist regulators in monitoring prescribing patterns for these drugs, and will also enable identification of patients who “doctor-hop” to obtain these drugs.

3 MOH would like to seek your views and feedback on this measure to monitor the prescribing and dispensing of benzodiazepines by doctors.

BACKGROUND

1 Benzodiazepines are drugs commonly prescribed for treating insomnia, anxiety and other medical conditions. However, long term inappropriate usage may result in physical dependence on the drug. Physical dependence refers to a state whereby the patient feels unable to cope without the drug, develops tolerance to the drug’s effects and thereby requires progressively higher doses to achieve the same therapeutic effect; withdrawal symptoms would also occur when the drug is discontinued. Benzodiazepine withdrawal syndrome includes a wide spectrum of symptoms including anxiety, agitation and restlessness, impaired concentration, and dizziness. In severe cases, delusions, psychosis, seizures and self-harm may occur.

2 The errant prescribing of potentially addictive drugs by some doctors is a recurring problem encountered by the Ministry of Health (MOH) and the Singapore Medical Council (SMC). Over the period 2007-2010, 42 doctors were dealt with by the Singapore Medical Council for disciplinary review in relation to errant prescribing of benzodiazepines.

3 Currently, MOH has a web-based drug prescribing monitoring system known as the Central Drug Prescribing Registry (CDPR)[1]. This was first implemented in 2005 to monitor medical practitioners’ prescription of buprenorphine. It is now used to monitor methadone prescription. Doctors were required to enter patient and prescription details into the system. In addition to monitoring prescribing patterns, the system also enables doctors and regulators to identify “doctor-hopping” behaviour of drug abusers who visit different doctors to get their drugs.

PROPOSED MEASURES TO MONITOR THE PROBLEM OF ERRANT PRESCRIBING OF BENZODIAZEPINES

4 Doctors who prescribe and dispense any benzodiazepine will have to enter patient and prescription details into the CDPR system. The system will allow regulators to identify prescribing patterns of doctors.

5 All benzodiazepines that are available locally will be monitored in the CDPR system:

(a) Alprazolam

(b) Bromazepam

(c) Chlordiazepoxide

(d) Clonazepam

(e) Clorazepate

(c) Diazepam

(d) Flurazepam

(e) Lorazepam

(f) Midazolam

(g) Nimetazepam

(h) Nitrazepam

When a doctor prescribes and dispenses any of these drugs, he/she will have to enter the patient and prescription details in the CDPR.

6 Before dispensing the benzodiazepine to the patient, the doctor will need to check the previous dispensing history for the patient via the CDPR system, and ensure that the patient had not “doctor-hopped” in order to obtain additional prescriptions and had not been receiving the drugs for an extended duration.

7 The proposed measure will apply to all medical clinics and hospital outpatient services.

8 The requirement to enter patient and drug details in the CDPR will provide regulators with information on doctors’ prescribing patterns of the benzodiazepines, and will provide the basis for implementation of additional measures to control errant prescribing practices if necessary. It will also enable identification of patients who visit different doctors to obtain a supply of these drugs.

THE MINISTRY WELCOMES YOUR VIEWS AND FEEDBACK

MOH would like to seek your views and feedback on the following:

(i) Would the proposed measure be useful in monitoring prescriptions of benzodiazepines? If not, what alternate measures would be appropriate?

(ii) What problems, if any, may be encountered with the implementation of the mandatory online reporting system for benzodiazepine prescriptions?

(iii) The proposed list of drugs to be monitored includes all benzodiazepines currently available in Singapore. Are there any drugs that should be added to or removed from the proposed list? If yes, what are these please?

Replies should reach the Ministry by 7 Jan 2012.

All feedback and comments should be addressed to:

“Feedback on Proposed Measures to Counter Errant Prescribing of Benzodiazepines”

Ministry of Health

College of Medicine Building, 16 College Road

Singapore 169854

This document is also available on the MOH website: http://www.moh.gov.sg

[1] Previously known as the Central Addiction Registry of Drugs Singapore (CARDS).