Doctors have contacted the MDU for advice after seeing adverts for drugs they may have prescribed to patients being sold online, including on Facebook groups and online auction sites. This raises concerns about whether the doctor might be unknowingly drawn into the illegal supply of the drugs, as well as making them question whether future prescriptions should be issued to the patient and if the police need to be informed.
Common medications being sold online include controlled drugs such as benzodiazepines and opioids, as well as erectile dysfunction drugs.
They add that buying drugs online without a GP prescription 'is risky, as medications should only be taken under the supervision of a health professional. Their guidance on whether the drug is suitable for you, the dosage, possible side effects, and any harmful interactions with other medications is crucial.'
The below case study is based on situations where the MDU has supported doctors facing this difficult dilemma.
Patient warned after selling drugs online
A GP contacted the MDU's advice line because a member of the practice team had noticed a Facebook page in which a patient of the practice appeared to be selling prescribed drugs, including diazepam and oxycodone. On checking the patient's notes the GP saw the patient had received repeat prescriptions of the drugs for a number of years.
It wasn't clear from the content of the website whether the patient was responsible for the page, but a person who the GP believed to be the patient's girlfriend had liked the page. The GP asked the MDU what she should do and whether she should tell the police.
The MDU adviser suggested that the GP should liaise with her colleagues to discuss the patient with those doctors that had seen him. The other doctors in the practice confirmed that the patient regularly attended for reviews of his medication and had never asked for replacement prescriptions in addition to those that were given on a repeat prescription basis. There was nothing to suggest he was not using his medications as intended.
The patient was asked in for a meeting to discuss the GP's concerns. At the meeting, the patient initially denied selling his medications, however, after the GP mentioned the girlfriend's apparent endorsement, he admitted doing so.
In situations such as this, the GP would need to consider whether the disclosure could be justified in the public interest. If he felt this was the case, he should inform the patient about his intention to disclose personal information, unless he felt it was not safe to do so. This decision is essentially a balancing act between the benefits to an individual or society of disclosing versus the harm to the doctor/patient relationship of disclosure.
Disclosure in the public interest without consent may be justified if failure to make the disclosure could expose others to a risk of serious harm or death. This could arise where disclosure might assist in the prevention, detection or prosecution of a serious crime, as outlined in the GMC's confidentiality guidance.
This guidance does not provide a specific definition of 'serious crime', but on page 35 of the Department of Health guidance Confidentiality: NHS Code of Practice the examples listed are murder, manslaughter, rape, child abuse, substantial financial gain/loss and risk of state security/public order.
The GP had also been told by a family member that the patient was selling the drugs to children. She concluded that a failure to inform the police of these allegations would leave individuals, and children in particular, at serious risk.
The member explained to the patient that she would be informing the police about the drug selling, providing the minimum information necessary. At a second meeting, the patient said he had stopped selling the drugs online. The GP established how much medication the patient was actually using and a plan was made to adjust the prescription, including the frequency of collection and dose reductions. The GP also informed him that his behaviour was detrimental to the ongoing doctor-patient relationship and that a warning letter would follow their meeting.
The GP was advised by the MDU to carefully document her discussions with the patient, including his confession, the reasons for her decisions and her clinical management plan.