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What if we're not happy to prescribe methadone?

Q We have today had a patient allocated to our practice who is addicted to dihydrocodeine and we have been advised we should prescribe methadone instead as this is more easily supervised. However, this is not a service we normally offer our patients as we do not believe we have the necessary training or experience to do so safely. We have been told there is a waiting list of several weeks at the local methadone clinic and the patient needs help urgently. What should we do?

You should not allow yourself to be pressured into prescribing something that is not normally provided in general practice and for which you lack the appropriate expertise. If you were to prescribe methadone and a problem occurred you would be held to be professionally responsible.

The appropriate course of action is to ask the patient if you may reveal sufficient confidential information to the PCT in order that he may be transferred speedily to the care of a practice that is able to help him effectively with his addiction.

In the event that the PCT refuses to re-allocate the patient, or if there is no practice locally with the necessary expertise to treat the patient safely, then you should record in writing that you believe you are unable to prescribe and monitor drug substitution therapy in a sufficiently professional and responsible manner.

You should also record that you hold the PCT responsible for arranging immediate specialist help. It would be necessary to send this information immediately by secure e-mail or using a safe-haven fax procedure.

This is the only way to ensure you are acting in your patient's best interests and taking your professional responsibilities and obligations seriously.

It would perhaps be sensible to alert your medical defence organisation to the problem at this stage so it can offer any further specific advice that may be necessary.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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