Prescription for profit

PHOTO: Prescription for profit

SINGAPORE - They are sworn to heal and do no harm.

Yet a growing number of doctors see no problem in improperly prescribing possibly addictive drugs to patients.

The reason - profit.

Doctors who spoke to The New Paper called some of their peers irresponsible for selling prescription drugs to addicts to make a quick buck.

One veteran doctor, who runs a general practice in Tampines, said it is a "well-known fact" that addicts clinic-hop to get their supply of prescription drugs, usually hypnotic drugs like benzodiazepines.

What he finds "disturbing" is how some doctors take the opportunity to make a fast buck by catering to these clinic-hoppers.

"The profit margin is very high, and that is why some doctors continue to do it," he said.

"For example, the controlled drug Valium costs us less than 20 cents per pill, but I have heard that some doctors sell them for $3 each."

Valium, a class of benzodiazepines, is used to treat anxiety disorders or muscle spasms, and is addictive.

In comparison, drugs such as antihistamines - used to treat the common cold - cost up to 15 cents per tablet, but are sold to patients for about 50 cents each.

Last year, the Singapore Medical Council (SMC) received 12 complaints regarding doctors involved in the excessive or inappropriate prescription of drugs, compared to six cases in 2009.

These numbers were released in the medical profession watchdog's annual report for 2010.

This year has seen, on average, a case a month of doctors taken to task for lax benzodiazepine prescription.


Last Monday, Dr David Tan Keok Kuan was fined $3,000 for inappropriately prescribing Subutex and Stilnox between November 2004 and December 2005.

The 49-year-old doctor from Yishun Central Clinic was suspended for three months with effect from Oct 6.

Stilnox, also classified under the benzodiazepines group, is a sleeping pill, while Subutex was introduced here in 2002 as a form of treatment to wean heroin abusers off their addiction.

The main purpose of Subutex, commonly sold as a pill that dissolves under the tongue, is to relieve the withdrawal symptoms from quitting heroin.

Such lax prescription of drugs is dangerous, said another doctor who runs a practice in the Orchard area, as it may lead to addiction.

"You always must be on your guard... if you are liberal in the use of hypnotics, patients can take advantage," he said.

Before Subutex was reclassified in 2006 as a controlled drug under the Misuse of Drugs Act, the Central Narcotics Bureau (CNB) found that errant doctors were prescribing Subutex indiscriminately to a ready queue of regular patient-addicts.

A 2mg Subutex tablet then cost between $8 and $10, and an 8mg tablet between $20 and $28.They fetched higher prices on the black market.

Since Aug 14, 2006, doctors can no longer prescribe and dispense take-home dosages of Subutex.

All patients who require it have to consume the medication under direct visual observation of the pharmacist, doctor or treatment team.

The distribution of benzodiazepinesis also strictly controlled, doctors told TNP.

In the case of Dr Tan, an SMC spokesman said it learnt of the situation after the Ministry of Health lodged a complaint in March 2008.

The spokesman said Dr Tan was not charged for profiting from the conduct complained of.

Instead, he was found guilty on eight charges, including the inappropriate prescription of the addictive medicines.

Dr Tan also did not keep a detailed record of his patients' history, diagnoses and symptoms over their treatment periods, which is needed to ensure the patients are given proper care.

Under the Poisons Act, medical practitioners are required to maintain such records, including the kind of drugs dispensed.

Dr Tan will have to give a written undertaking to the SMC that he will not engage in the same, or similar, conduct again. He must bear the cost of the proceedings.

The doctors interviewed declined to say how many benzodiazepines they dispense each month.

Typically, each patient is give three or four pills per consultation. Those who ask for more are referred to either a psychiatrist or hospital for further consultation.

While doctors here agree that tougher measures will deter errant physicians, that won't stop addicts from clinic-hopping in the hope of scoring drugs.

Said one doctor: "I still have people coming to either my nurse or myself hoping to buy controlled drugs like Valium.

"I never entertain them. In fact, they back down every time I say the only way they can get the drugs is after a consultation with a psychiatrist or a hospital."


This article was first published in The New Paper.