BY: LUCY MARTIN
If you've broken a bone or had a painful operation then you've probably taken them without a second thought; they're called drugs of addiction and they include substances such as morphine, codeine and pethidine.
Doctors prescribe them as painkillers and they're perfectly legal but also highly addictive.
The State Government has introduced new laws to Parliament designed to better monitor the use of prescription drugs and prevent so-called "doctor shopping".
The Medicines, Poisons and Therapeutic Goods Bill 2013 will compel doctors to report drug dependent patients and so-called doctor shoppers to the Health Department.
The department may then place their names on a state-wide drug addict register.
But critics fear the new laws will damage the relationship between doctors and patients and discourage vulnerable addicts from seeking help.
Doctor shoppers beware
West Australians sought help for drug-related problems on more than 13,500 occasions in the last financial year.
Seventeen per cent of those cases involved legal prescription drugs.
Some people will do anything to obtain the drugs, including stockpiling prescriptions from dozens of doctors.
It's called doctor shopping and, according to WA's Pharmacy Guild's president, Lenette Mullen, it's a big headache for GPs and pharmacists.
"They'll have a good story, they'll tell it to one doctor, get a prescription and get it dispensed at as nearby pharmacy," she said.
"Then they'll move onto another suburb, another two suburbs....it's a big problem."
Some doctor shoppers sell the drugs on the black market while others collect them for personal use.
Currently there's no way for pharmacists to report suspected doctor shoppers to health authorities but that's set to change.
The new laws, currently before Parliament, will allow pharmacists to report suspected "oversupplied persons" to the Health Department for the first time.
Similarly, doctors must report "oversupplied people" to the department, which may then place them on a drug addict register called the Drugs of Addiction Record.
The real-time record can be checked by doctors before prescribing a patient certain drugs.
"The hope is that those people can then actually get help," Mrs Mullen said.
Casting the net too widely?
Under current laws, doctors who suspect their patient is a drug addict must report them to the Health Department within 48 hours or risk a $1,000 fine.
The patient could then be placed on the drug addict register.
But the new legislation defines a reportable patient as a "drug dependent" or "oversupplied person", rather than an addict.
Drug dependent is defined as "someone who has acquired...an overwhelming desire for the continued administration of a drug of addiction or schedule 9 poison."
Perth doctor and AMA WA president Richard Choong says it's a subtle but important change.
"It is very vague and part of the problem that we face is that we're trying to capture a few people, but instead they've created this legislation that casts its net too widely," he said.
Dr Choong uses an example of a patient who came to him after breaking their hip and undergoing a painful operation in hospital.
"So they've been given short-acting opioids which are morphine-based drugs that have quite a highly addictive nature to them," he said.
"This patient is taking their medication in good faith to control their pain but the drug latches onto them.
"So, now we've created a situation where the patient is inadvertently addicted to the drug.
"In those circumstances [the addiction is] identified quickly and we bring them off the medication but that patient, who has done nothing wrong, may inadvertently be captured by this new legislation."
The penalty for failing to report such a patient has also jumped from $1,000 to $15,000, although the Health Minister says he's happy to reduce that to $5,000.
Dr Choong says it's a lose-lose situation for doctors who must decide between the hefty fine or betraying their patients' trust.
He says the threat of being placed on such a register will deter people from seeking help.
"If they know they're going to be placed on a register that could haunt them for the rest of their life, they won't turn up and we won't be able to do what we're supposed to do and help them," he said.
Dr Choong wants the Health Minister to reconsider the rules around compulsory reporting.
"If you actually have more education and support for doctors to know what to do with these patients then you'd get the same outcome [without] damaging the doctor-patient relationship," he said.
Refusing to report
Under existing laws, almost everyone who walks through addiction specialist George O'Neil's door should be reported to the department.
But, Dr O'Neil willingly admits to ignoring current laws for the sake of his patients and vows to continue doing so.
"Having treated thousands and thousands of patients and not [given] their names to the Health Department, nobody's come to sue me," he said.
"If they're going to sue me for $15,000 per patient I'd be broke tomorrow."
Dr O'Neil says his clients come from a range of backgrounds, but all of them want to be treated confidentially.
"Lots of lawyers, teachers and doctors have come to me and said I won't be treated unless you treat me confidentially and I've said of course," he said.
The Health Minister Kim Hames says doctors who fail to report certain patients are not acting in their best interests.
"While the doctor might want to work [with the patient] on a one-on-one basis, what they don't know is whether that patient is going to other doctors and getting medication," he said.
"While they're trying to help someone get off, that patient might be seeing ten other doctors and getting the same drug."
Dr Hames says the new laws are designed to protect and monitor, rather than stigmatise, prescription drug users.
"If a patient is working with a doctor to get off (drugs), then it's in the doctor's best interest to have that patient on the register so they aren't tempted to go and seek alternative medication from other doctors," he said.
WA's Drugs of Addiction Record already has 14,000 names on it.
Dr O'Neil says being on the list is a terrible burden for his clients to bear.
"People who come to us are not doctor shoppers, they're here to get rid of their addiction and this is punishment on top of their addiction," he said.
"It causes a great deal of distress to many families, I tell them it doesn't matter but of course it does to them.
"The fact that the government has got their name recorded as an addict is very crippling to some people."
Perth man Bruce* is a former heroin addict who has been clean for 17 years.
He was added to the register as a result of starting a methadone program and remains on the list today.
Bruce says being there has made it difficult for him to get certain medications, even for valid reasons.
"It's been terrible because every time I go to hospital I have to jump through hoops to get certain medication," he said.
He says being on the list also changes people's attitudes towards him.
"People are initially nice to me when I'm first presented at hospital but when they find out about my drug history things change dramatically," he said.
Bruce is now a drug counsellor at a Perth clinic but says his past continues to haunt him.
He says the threat of being placed on a drug addict list already deters people from seeking help and the changes will only make it worse.
He's not sure how to go about getting his name taken off but that's something the new laws aim to change.
Dr Hames says it will be easier to get off the list and the process of putting people on is more transparent.
"[To get off] you'll have to prove that either you're on there by accident or that you've long since given up drugs," he said.
"In terms of getting on, what will happen is the doctor notifies the chief executive of the health department, who has to contact the patient to let them know."
People will be then given an opportunity to show why their name shouldn't be added to the register.
Dr Hames says access to the register is strictly controlled and doctors will only look it up if their patient has requested certain drugs.
The bill is expected to pass both houses of Parliament this year and come into affect in 2014.
*Name has been changed.