Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
Monash Addiction Research Centre, Monash University, Peninsula Campus, Melbourne, Australia.
Drug Alcohol Rev. 2019 May;38(4):366-376. doi: 10.1111/dar.12918. Epub 2019 Mar 18.
Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines 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. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors.
Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63-640.11) and pharmacists (AOR 85.59, 95% CI 5.08-1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80-97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01-0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50-157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24-20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1.52-41.75). 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.
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.
全球范围内，包括澳大利亚在内，越来越多的人出于医疗目的以外的原因使用药物，导致危害不断增加。本研究旨在调查澳大利亚卫生从业者（HP）在药物滥用中的作用以及他们不当开药/配药或滥用药物的相关情况。
从澳大利亚法律信息协会获取了 2010 年至 2016 年期间的法庭判决，共 117 起针对 HP 不当开药/配药或挪用药物的投诉，对这些案例进行了全面检索。使用二变量和多变量逻辑回归来检查不同人群、药物类型、规模和贡献者的不当行为模式。
涉及不当开药/配药（73%）的案例更有可能涉及医生（调整后优势比 [AOR] 48.18，95%置信区间 [CI] 3.63-640.11）和药剂师（AOR 85.59，95% CI 5.08-1443.05），且涉及年龄在 50 岁以上的 HP（AOR 16.54，95% CI 2.80-97.60），涉及个体情况的可能性较小（AOR 0.06，95% CI 0.01-0.57）。涉及挪用（31%）的案例更有可能涉及护士（AOR 19.86，95% CI 2.50-157.93），年龄在 40 岁以下的 HP（AOR 5.08，95% CI 1.24-20.90）和归因于个体情况（AOR 7.96，95% CI 1.52-41.75）。亚组分析表明，医生更有可能不当开出处方类阿片类药物、镇静剂和附表 8 类药物，他们的不当行为归因于缺乏管理复杂患者群体的技能和性情，而药剂师则更多地因经济原因参与伪麻黄碱供应。
减少药物滥用的策略应该是多方面的，可能包括更好地支持 HP 管理复杂的患者群体，并为 HP 提供治疗药物滥用的机会。
