Table of Contents
This paper presents a literature review on the prescription of schedule 8 medication in Australia, and the legislation guiding the same. It derives information from secondary sources and seeks to identify some of the major issues associated with the prescription of the schedule 8 medication. Among these issues, it identifies: treatment of drug-dependency patients; increased sources of illicit controlled substances; an increased need for therapy medication; managing dependency in patients; and the abuse of medication. The paper then narrows down to Australia, focusing on relevant legislation and requirements for doctors prescribing schedule 8 medication. Additionally, the paper identifies gaps within the research available on the adherence of schedule 8 prescriptions to available legislation in Australia. Following this review, the paper is summarized into a conclusion.
Schedule 8 medications are the drugs that are used for the purposes of therapy and that have a high possibility of addiction and abuse (Bryant, Knights & Salemo, 2010). Their prescription to patients should be guided by the fact that in as much as the patients need them to get well, controls need to be put in place to ensure that these drugs are not misused. Misuse of such drugs can lead to dependence and, therefore, their medical objective will not be attained (Cohen, 2007). Examples of these drugs include cocaine and amphetamine.
Not every medical practitioner can prescribe these drugs (Fulco & Liverman, 2010). Their prescription is often limited to specialists such as psychiatrists. In fact, every specialist who prescribes them should be licensed and authorized to do so by a relevant governing body, failure to which unauthorized prescriptions may lead to the drugs being misused. Permits require extensive scrutiny of a doctor’s credibility, with a background check on their integrity and usage of drugs to ensure that they do not take advantage of their access to the drugs to fulfill their drug-dependencies (Arif & Westermeyer, 1988).
Key Issues Associated with Prescribing Schedule 8 Medication
Treating drug-dependent patients
Drug-dependent patients are those that are already, in some way, addicted to a particular drug. Such drugs can include the above-mentioned controlled medication that are used for the treatment of therapy but that are also highly associated with addiction. In such cases, medical practitioners have to take caution when dealing with patients (Avorn, 2005). There are basic knowledge areas that doctors need to put into practice when dealing with such patients. To begin with, they should be authorized to handle such patients, and the medication that they are dependent on. Various regulatory bodies give this kind of authorization, depending on a country and its jurisdiction. Once this authorization is attained, the doctor can go ahead and plan on how to support the drug dependent patient (Nixon, 2012).
According to Conrick (2005) an issue arises when prescriptions are required and the patient is already dependent. To identify the level of dependency, various questions need to be asked by the doctor. Additionally, a thorough background check of the patient may be necessary. Cases have arisen of patients who have been found with a history of forging prescriptions, buying dependency medication from illegal sources, manipulating doctor-written prescriptions to add their dosage and even bribing hospital and pharmacy attendants to give them the medication, even if at a price, as long as they can get the amounts that they need (O’Mahony & Lucey, 2008). If any of such cases are identified by the doctor, medical action needs to be taken to deal with the already dependent patient (Dasgupta, 2010).
Following up on a patient’s history is a reliable method of identifying whether or not they are or have ever been dependent on a certain medication (Staunton & Chiarella, 2016). However, this history might not be readily available in some developing countries, especially where computerized data management and profiling systems are yet to take over as the main storage methods (Cole, 2003). In these circumstances, doctors, on suspicion of dependency, may have to prescribe drug tests to confirm the levels of a dependent substance in a patient before they can go ahead and prescribe another controlled medication (Ehrenpreis & Ehrenpreis, 2001).
Increased illicit sources of dependent medications
Schedule 8 medication has created an illegal market of its own (Forrester & Griffiths, 2010). Due to the growing demand for such medication, a lot of illicit sources have emerged. These include illegal manufacturers of the medication, people who steal them in bulk from hospitals and factories to sell, and people who get them through the correct prescriptions but opt to sell them for money (Schecter, 1981). Additionally, there is a growth in the black market where such medication is easily available through masked online purchases. Some licensed pharmacists also operate haphazardly and do not put in the required effort to validate the prescriptions presented to them, leading to an increase in the misuse of such medication (Strain & Stitzer, 2006).
Controlling the illegal sale of schedule 8 medication requires a lot of financial and personnel resources to ensure that only appropriate prescriptions are attended to, and that illegal manufacturers and distributors are halted. However, with the growing use of the dark web and crypto-currency, black market transactions have been made easier than they used to be and more difficult to trace (Selinger & Barrow, 2017. However, strict measures and guidelines, as well as government policies, laws and consequences should be put in place to: educate people on the risks of schedule 8 medication; warn peddlers of consequences of selling these medications; and protect individuals from dependency (Townsend & Luck, 2013).
Increased need for therapy medication
Studies show that there is currently an increase in the cases of psychological issues such as depression, anxiety, ADHD, PTSD, among others (Freeman & Tyrer, 2006). Additionally, research has shown that the current medical practices across the globe have developed a tendency of prescribing drugs to treat conditions or situations that a normal human brain can recover from. Cases of anxiety, extreme sorrow and depression are due to losses or lack of gaining whatever one had planned for, or even due to high expectations. However, such cases are currently treated as psychological issues and are given an urgency that calls for immediate therapy and treatment as described in Jotterand and Dubljevic (2016).
Following this understanding, there is an equivalently increased rate of manufacturing and prescribing medication intended to deal with such cases. This category of supposed illnesses is controlled by the use of some schedule 8 medication that can be highly addictive (Bullock & Manias, 2013). The increased demand for anti-depressants, stress relievers and anxiety pills, as well as sleeping pills has led to the depreciating capability of the human brain to function as a psychological healer (In Warkentin & Decision Sciences Institute, 2015). As a result, prescriptions for schedule 8 medication have also been on the increase.
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Managing dependency in patients
Patients with a dependency on drugs can also be in need of therapeutic or pain reliving care (Koutoukidis, Lawrence & Tabbner, 2008). This kind of care might call for the use of schedule 8 medication. As long as the patient meets this conditions, a doctor should get authorization for them to make the prescription. It is wrong to allow patients with a dependency to continue using a schedule 8 drug without a relevant understanding of the consequences that such drugs may have on them, in addition to cementing their addiction (Buzzeo, Angarola & Siecker, 1995).
A doctor should not support a patient’s dependency by supplying them with dependency medication (Kreit, 2013). Instead, they should monitor the dependency and calculate the dosage as is required to avoid excessive use that could worsen the addiction to the drug. Many patients report seeking dependency drugs based on their urge to use them, considering the addiction programs their bodies to fail in efficient functionality and normality if they are not on such drugs.
Abuse of dependency drugs
According to the United Nations, prescription drug abuse is an issue of global concern. This abuse is mostly associated with overdose of these drugs. Of the overdose cases reported in the US, Europe, Asia and Australia, 60% are characterized by death or the rendering of a victim into a vegetative state due to the destruction of the brain’s functionality (Selinger & Barrow, 2017). With this in mind, it is evident that the prescription of dependency drugs is not as per legislation in many parts of the globe, resulting in the misuse of the drugs.
The Case of Australia
According to the Coroner’s Court of Victoria, 80% of deaths caused by the overdose of drugs involved opioids and benzodiazepines. In 2013 alone, Australian adults that obtained non-medical pharmaceuticals made up 4.8% of the entire adult population. Needle and syringe program participants rose to 23% for the year 2015 from 7%, indicating a rise in the use of intravenous drug use in the country (Jotterand & Dubljevic, 2016).
The above statistics indicate that there is misuse of pharmaceuticals in the country of Australia. The increased number of overdose cases as per the coroner’s report indicate that there is an increased usage of dependency drugs. Opioid is identified as a major killer in Australian adults (Ghodse, 2002). This medication is a schedule 8 one that causes addiction in its users. The fact that individuals have obtained it for non-medical purposes is a sign that legislation is not followed adequately in ensuring that prescriptions are adhered to, or that pharmacists put in place controls that assist in eradicating the abuse of medication (Levison, maloff & ABSS, 1980).
In Australia, the NSW Ministry of Health has the mandate to issue authority for the prescription of schedule 8 medication (). Therefore, any misuse of these drugs can be traced down to illegal prescription or distribution of the drugs categorized as schedule 8, including opioid. The authorization from this body is clearly outlined as guiding prescription of these drugs to drug-dependent patients. Additionally, it gives a guidance for prescribing these medications to patients who are not drug-dependent but who have a history of injecting drugs; usage of drugs directed to mucus membranes; and usage of some drugs such as methadone and flunitrazepam, as well as other schedule 8 drugs either legally or otherwise (Levison &Maloff, 1980). Exemptions exist, however, for some medical cases such as when the drug is to be given to an inpatient person, but the authorization has to be obtained if the patient is admitted for more than 14 days (Griffin & Wiley InterScience, 2009).
Cases have previously been noted where doctors were not aware that they had to obtain authorization to prescribe schedule 8 medication (Low, Hattingh & Forrester, 2009). Such cases were common where a prescription was to be given for more than 8 weeks. In the Australian medical practice, schedule 8 medications should not be prescribed to non-dependent patients for a period exceeding 8 weeks. The risk of a long-term prescription is the dependency that may develop. This can be avoided by managing the dosage prescribed to the patient.
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In addition to the lack of knowledge on the need to seek authorization from territory health authorities, some doctors have been cited as not being aware of the legislation guiding prescription of schedule 8 medication in their states (Mirin, Gossett & Grob, 1991). Such include the Poisons and Dangerous Drugs Act, as well as the Poisons and Therapeutic Goods Act 1966 applicable in NTY and New South Wales respectively. These Acts are among the legislation that should guide Australian doctors in prescribing schedule 8 medication.
Permits for prescribing schedule 8 medication are given on certain conditions (Mckenzie & Porter, 2011). One such condition is that the daily dosage should not exceed 100 milligram in the equivalent of morphine. Secondly, the patient should not have any history of dependence on drugs, unlawful behavior as associated with drug abuse or medication prescription and if the patient has already received treatment with an opioid for a period that exceeds 12 months. Exemptions exist in cases where individuals are treated in a controlled environment, where misuse of drugs or overdosing is highly unlikely such as in prisons (Mckenzie & Porter, 2011).
Research on the prescription of schedule 8 medication as per legislation and regulations of the Australian Health Department lacks areas concerning the control of illicit prescription or distribution of these medication. Little research is available on methods that are effective in identifying the sources of illicit opioids and their manufacture and distribution. Additionally, increased deaths caused by the overdose of dependency drugs indicates that there is a gap in the control of illegal distribution, manufacture and usage of schedule 8 medication. However, there is little that can be relied on with regard to the viable methods that can be used to ensure that the illegality of some prescriptions and usage of these medicines are stopped.
There is also a research gap in the identification of ways in which addictive schedule 8 drugs can be manufactured in ways that reduce their rate of addiction while maintaining reasonable and effective dosages. Studies focus on the usage of the medication, and the associated effects of misuse and uncontrolled prescriptions. However, little has been documented on the alternative manufacturing options that can be relied upon to produce therapy medicine that will be helpful to patients that need schedule 8 medicines.
The applicability of Australia’s legislation in other regions of the world has not been documented adequately. Australia, through its Department of Health and state-led medical initiatives, has managed to come up with legislation that governs the prescription of schedule 8 medication. Additionally, directives and guidelines on prescriptions, including the authority to make them, has been focused on in a big way, creating an environment that portrays a high level of caution on the prescription of controlled substances. However, adequate research has not been done to show the effectiveness of the equivalents of Australia’s legislation in other regions.
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This paper has focused on the schedule 8 medication, and how legislation seeks to control them. To do so, the paper has looked at secondary sources to identify the general view of the topic across the globe. This general view has involved the issues associated with schedule 8 medication prescription. Additionally, the paper has narrowed down to Australia, seeking to present information on the possibility of prescribing schedule 8 medication as per legislation. Through this section, the paper has gone through legislation, regulations and requirements for authorization before an individual can prescribe a schedule 8 medication. Further, the paper has identified gaps in the research and literature available with regard to schedule 8 medication prescription. In the review of gaps, the paper has identified inadequacy in studies associated with effective methods of reducing illicit distribution and possession of schedule 8 medication, alternative manufacturing methods that can reduce the addictive nature of the drugs, and the applicability of Australia’s legislation to the rest of the world in managing controlled substances effectively.
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