UK regulations have been designed to “protect and promote patient safety”, Ms Steele told C+D.
It is “extremely important that...appropriate safeguards” are put in place, especially with medicines that are liable to “misuse, abuse and overuse”, Ms Steele explained.
Ms Steele said the CPPSG had “regrettably” been made aware of “a number of cases in which patients have tragically died after accessing medication from multiple or online providers”.
The coroner's report linked to one such case implied that “the medication was prescribed by a company...[that] was subject to limited regulation”, she said.
Access to “excessive” online opioid-based drugs
Twenty-eight-year-old university student Jamie O’Connor was found deceased in his Leicester home on October 14, 2018.
Her Majesty's assistant coroner in Leicester City and South Leicestershire, Dianne Hocking, commenced an investigation into his death two days later, on October 16.
The resulting report, filed at the conclusion of the inquest on October 21 of this year, found that Mr O’Connor had accessed “excessive” opioid-based drugs online, on top of his regular prescriptions.
The coroner wrote that the company prescribing drugs to Mr O’Connor had “limited regulation”, “by virtue of where [it] was registered”.
Ms Steele cautioned providers that prescribe and dispense medication remotely to follow the relevant guidance published by the General Pharmaceutical Council (GPhC), the General Medical Council (GMC) and the Quality Care Commission (CQC).
It “extremely important” that they implement “appropriate safeguards”, “particularly when prescribing and dispensing medicines that are liable to abuse, misuse and overuse”, she added.
“This extremely sad case”, Ms Steele said, also highlighted “the importance of good communication between health care professionals”.
Lack of information sharing
Mr O’Connor suffered from both mental and physical illness, for which he was prescribed “appropriate” medication by both a psychiatrist and a GP, Ms Hocking wrote in the report.
However, neither clinician was aware that Mr O’Connor was accessing additional medication online in “excessive” amounts, as he “specifically did not give permission for information sharing” between the two.
Ms Hocking addressed the report to the health secretary, the GPhC, and the chief executives of the GMC, CQC and NHS.
The GPhC will reply to the coroner’s report, a spokesperson for the regulator told C+D, while “investigating concerns in connection with the inquest into the death of Jamie O’Connor”.
No remote prescription tracking system
While Ms Hocking did not describe specific actions that companies should take, she identified areas of concern within Mr O’Connor’s case.
The lack of “tracking system or central database” between dispensers and providers meant that their systems were “open to abuse” by patients, she said, as there was no way to track what medication a patient has been prescribed and by whom.
As a result, she wrote, a patient requesting drugs “has potential access to multiple online pharmacies”, each of which “have no knowledge of what each other have been prescribing”.
As such, pharmacies are at risk of overprescribing or dispensing contraindicated drugs, Ms Hocking explained.
Information sharing and GPhC guidance
Ms Hocking also expressed concern over that lack of information sharing between GPs and pharmacies, noting that online pharmacies were not required to contact a patient’s GP “to let them know what has been prescribed”, thus eliminating opportunities for “further enquiries to be made” in the case of a red flag.
However, the GPhC guidance for registered pharmacies providing pharmacy services at a distance, which it amended in 2019, encourages online pharmacies to ask the patient for “the contact details of their regular prescriber, such as their GP, and for their consent to contact them about the prescription”.
The GPhC’s distance-selling guidance advises that online pharmacies implement the following measures (find the full guidance here):
- Pharmacy staff must decide which medicines are appropriate for supplying at a distance, including on the internet
- Pharmacies must make sure pharmacy staff can check that the person receiving pharmacy services is who they claim to be, by carrying out an appropriate identity check
- Pharmacies must identify requests for medicines that are inappropriate, by being able to identify multiple orders to the same address or orders using the same payment details – this includes inappropriate combinations of medicines and requests that are too large or too frequent.
C+D reported earlier this month (December 7) that the GPhC was considering charging online pharmacies “differentiated” annual registration fees to cover the increased regulatory activities the rapid growth of the sector has elicited.