Home' Australian Pharmacist : Australian Pharmacist November 2015 Contents Australian Pharmacist November 2015 I ©Pharmaceutical Society of Australia Ltd. 71
A young female client presented with a prescription for her regular
medication, Paxtine 20 mg 30 tabs 5 repeats.
It was the second dispensing of this
prescription. Her dose had recently been
increased to 2 tablets [40mg] daily.
She requested of the pharmacist that
she be given the four remaining repeats
together because she 'was tired of having
to come in every two weeks to pick up her
medications' and she was going away
on her school break to take a vacation
in the next fortnight. The pharmacist,
also a young early-career pharmacist,
was empathetic and asked several
questions, which the patient answered
steadily, with an almost detached attitude.
She gave details of her planned travels
and reported she was doing well on her
new dose of medication. Her answers and
general demeanour were convincing.
The pharmacist decided to dispense
the remaining packs of the medication,
with an annotation on the patient file of
the interaction. It wasn't normal practice
to provide all repeats on a prescription to
clients of the pharmacy, but the young
pharmacist felt the story was authentic.
Unfortunately, as the pharmacist was soon
to learn, the story was far from authentic.
The young patient proceeded that evening
to ingest the contents of all four packs of
Paxtine in an attempted suicidal episode.
She was found by her father and taken
by ambulance to hospital for emergency
treatment. The hospital report confirmed
the contents of the patient's stomach
were all paroxetine, but thankfully it was
not lethal and the patient survived the
The question is: will the young
pharmacist survive the wrath of the
patient's father and the consequences of
her decision to believe the patient and
dispense her repeats in one dispensing
transaction? The furious father took legal
action against this young pharmacist,
claiming negligence and lack of care.
And sadly, the pharmacist could be
found liable, at least to a certain degree.
This is a lesson for us all to remember
NEVER to be complacent about legal
requirements of dispensing, particularly
when it comes to Regulation 24 or at
the very least, a reminder of the need to
consult with patients' physicians in the
question about increased supply.
Issues to ponder
Whilst listening to this encounter,
and feeling the angst that the young
pharmacist is living in, I couldn't help but
wonder what would have happened had
the patient chosen simple paracetamol
for her attempt at suicide and caused
herself irreversible liver damage
without ever needing a prescription
medicine? It almost certainly would
have caused her attempt at suicide to
succeed, with an awful outcome for the
angry father. But she hadn't. And what
happened should not have happened,
had the pharmacist been firmer in
not responding to a client's story,
and adhered to regulatory requirements
relating to Regulation 24.
There are also a number of issues here
that can be flagged, the most important
being the nature of mental illness and
the unpredictable behaviour that is
a hallmark of the affliction. Can we
ever predict this kind of behavior?
Perhaps not, but we do need to be
alert to any hints or signs, like this one,
where the patient is seeking extra supply
Dr Betty Chaar is Senior Lecturer and MPharm Co-
ordinator at the Faculty of Pharmacy, The University
of Sydney. Opinions expressed in this column are not
necessarily those of the Pharmaceutical Society, its
Board or staff.
of medication. Therefore it is wise to
take utmost precaution. It is also wise to
consult other healthcare practitioners
on every detail if the need arises, so all
healthcare providers involved in the care
of the mentally ill patient are working in
The other issue is that Regulation 24 is
there for a reason; and this incident
illustrates quite clearly why it is in
place. The temptation to use medicinal
products for purposes other than
therapeutic is not uncommon, and as
pharmacists are the 'gatekeepers' of
all medicines it falls upon us to ensure
that misuse is avoided as best as can
This was an easily avoidable situation,
but one which will undoubtedly
scar this pharmacist for a lifetime of
practice. Even if the pharmacist was to
have an empathetic judge in the civil
court arena, it is highly unlikely this
will pass without some penalty at the
professional level, and that only after
many months of suspense and anxiety.
There is an important statement in
the Code of Ethics for Pharmacists that
often appears in investigations of
'Professional judgment must be exercised
to prevent the supply of products likely
to constitute an unacceptable hazard to
health or the supply of unnecessary and/
or excessive quantities of medicines or
products, particularly those which have a
potential for abuse or dependency.'
Pharmacists, young and old, please use
your professional judgment, not your
personal leanings, when dispensing
-- even though we are meant to be
empathetic and respectful. There are
limits to the scope of our practice that
are there to protect us as well as the
public from harm.
Regulation 24 is there for a
BY DR BETTY CHAAR
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