Pharmacist Suspended for Unsafe Online Prescribing of Opioids and Z-Drugs

The General Pharmaceutical Council (GPhC) Fitness to Practise Committee investigated a pharmacist after concerns were raised about unsafe online prescribing practices at Instant E-Care Ltd.

Between April and October 2019, while working as an Independent Prescriber, he:

1. Prescribed opioids and Z-drugs excessively, without adequate clinical checks.
2. Did not review patient histories properly before issuing prescriptions.
3. Allowed patients to pre-select medications, dosages, and strengths without meaningful oversight.
4. Prescribed outside his area of competency, issuing medicines for chronic pain and mental health conditions despite limited training.
5. Failed to contact patients’ GPs, even when consent was given, before prescribing controlled drugs.

The GPhC was alerted when a journalist from The Times obtained 200 dihydrocodeine tablets via the Instant E-Care website, exposing loopholes in the pharmacy’s opioid policy.

Findings:

The Fitness to Practise Committee found that the pharmacist’s conduct amounted to serious professional misconduct, considering:

1. Unsafe and Excessive Prescribing of High-Risk Medications:
   • He regularly prescribed opioids and Z-drugs for extended periods without appropriate medical oversight.
   • An expert witness described his prescribing patterns as “excessive” and “potentially dangerous.”
2. Lack of Clinical Judgment and Professional Oversight:
   • He prescribed medicines for conditions such as chronic pain, hormonal disorders, and mental health conditions, despite limited training in these areas.
   • He ignored company guidelines on opioid prescribing, overriding internal safety policies.
3. Failure to Communicate with Patients’ GPs:
   • He did not contact GPs, even when patients consented, missing an opportunity for vital medical oversight.
   • This increased the risk of inappropriate prescribing and medicine misuse.
4. Manipulative Online Prescribing System Allowed Patients to Circumvent Safeguards:
   • Patients could pre-select medicines, strengths, and quantities, effectively controlling their own prescriptions.
   • The system allowed patients to alter answers on the questionnaire to ensure approval, bypassing safety measures.
5. Breach of Professional Standards and Public Trust:
   • The pharmacist ignored fundamental principles of safe prescribing.
   • The committee noted:“Pharmacists are gatekeepers of prescription-only medicines. The deficiencies in the Registrant’s practice were serious, fundamental, and wide-ranging.”

GPhC Determination on Impairment:

The GPhC ruled that the pharmacist’s fitness to practise was impaired, citing:

• Significant patient safety risks due to poor prescribing practices.
• Public confidence in pharmacy professionals being severely undermined.
• Failure to demonstrate full remediation of past errors.

The committee expressed concerns about the registrant’s lack of insight, stating:

“The Registrant has not sufficiently demonstrated remediation. He continues to rely on vague assertions that he will ‘work within his competence,’ but he has not provided concrete evidence of how he will prevent past mistakes from happening again.”

The GPhC concluded that his errors were so severe that a clear regulatory response was required.

Sanction:

The committee imposed a 9-month suspension, considering:

• Aggravating Factors:
  • Prescribing outside competency and training.
  • Failure to conduct clinical checks before issuing opioids and Z-drugs.
  • Ignoring internal safety policies.
  • Potential risk of serious patient harm.
• Mitigating Factors:
  • The pharmacist admitted all allegations early in the hearing.
  • He engaged in professional development and took part in supervision at a GP practice.
  • His current employer provided positive testimonials about his prescribing competence.

However, despite these mitigating factors, the committee ruled that:

“The need to uphold public confidence in the profession demands a suspension. The gravity of the pharmacist’s misconduct in the context of online prescribing warrants a clear regulatory response.”

A review hearing will be required before he can return to practice, ensuring that he has sufficiently addressed the concerns raised.

Key Learning Points for Pharmacy Professionals:

This case highlights critical lessons regarding online prescribing, patient safety, and professional accountability.

1. Online Prescribing Must Be Safe and Evidence-Based:
   • Pharmacists must ensure robust clinical assessments before issuing prescriptions.
   • Allowing patients to self-select medications is unacceptable and unsafe.
2. Opioid and Z-Drug Prescribing Requires Stringent Oversight:
   • Long-term use of opioids and Z-drugs should be monitored carefully.
   • Pharmacists must consult GPs and ensure proper risk assessments.
3. Failure to Communicate with GPs Can Have Severe Consequences:
   • Ignoring GP involvement increases the risk of medicine misuse and patient harm.
   • Best practice requires collaboration with other healthcare professionals.
4. Public Confidence in the Profession Requires High Standards:
   • The committee highlighted concerns about public trust in pharmacy professionals.
   • Unsafe prescribing damages the profession’s reputation.
5. Regulatory Bodies Take Unsafe Prescribing Seriously:
   • The GPhC imposed a significant suspension to reinforce the importance of safe prescribing.
   • Pharmacists must ensure they have the necessary training and competencies before issuing prescriptions.