EU loophole that means dangerous painkillers are doled out at the click of a mouse
France and Italy have closed it. But Britain hasn’t — and it’s putting lives at risk ...
As a young man, Richard Breatnach seemed to have it all. The son of an eminent Dublin radiologist, with his family home an elegant Victorian mansion on a leafy street in an exclusive part of the city, he attended the elite Jesuit school, Gonzaga College, where he is remembered as a keen and talented actor.
His death at just 31, in Brighton two years ago was, by complete contrast, a tragically squalid affair. He had become dependent on opiates and was killed by an overdose of the powerful painkiller dihydrocodeine, usually prescription-only, that he had bought online.
This drug is twice as strong as the codeine contained in over-the-counter painkillers and it is highly addictive.
Richard’s GP had refused to prescribe opiates, having seen through his claim to need them for chronic pain. Richard discovered another way to obtain dihydrocodeine — in lethally huge amounts, and without even leaving his home. What’s more, it is entirely legal.
Richard found a website run by Bolton-based company HR Healthcare that sold prescribed drugs online. He had only to fill in a questionnaire, which took just 15 minutes to complete, to obtain prescription-strength dihydrocodeine. In it, he claimed he needed the drug for migraines.
This was signed off by a European Union-qualified GP working for the website — without ever meeting Richard or reading his medical notes. The tablets were posted to him within days.
at his inquest in august 2016, the coroner Victoria Hamilton-Deeley heard expert evidence that dihydrocodeine should not be prescribed for migraine, not least because of its addiction risk.
she also heard that Richard had been sent an astonishing total of 126 high-strength tablets in one batch. Patients are normally told to take a maximum of four a day. It was on this batch that Richard overdosed.
The coroner noted that no effort had been made to contact Richard’s GP or to doublecheck the information he’d given.
Following the inquest, Miss Hamilton-Deeley was moved to write to the medical director of NHs England, sir Bruce Keogh, highlighting the perils of this legal conduit to powerful prescription drugs. she also wrote to HR Healthcare, demanding that it take action to safeguard customers in future.
The coroner is not the only authority to be disturbed by the fact that anyone can fill in an online prescription form, have it signed off by a doctor anywhere in the EU — without ever being physically examined by them — and then receive large amounts of addictive and potentially lethal prescription drugs such as opioid painkillers and benzodiazepines (given for anxiety and sleep).
It may sound frighteningly dubious, but it is perfectly above board, thanks to Britain’s interpretation of EU regulations.
ONlINE prescribing sites are allowed to sell drugs such as dihydrocodeine on the principle that EU-qualified GPs and pharmacies should be able to prescribe to any EU citizen, explains lynda scammell, senior policy adviser at the government watchdog, the Medicines and Healthcare products Regulatory agency (MHRA).
‘We normally find that these doctors who are supposed to monitor people’s online questionnaires are registered in countries such as Romania and Bulgaria,’ she told Good Health. (Other countries such as France and Italy have banned patients from getting drugs prescribed online by doctors outside their national borders, Ms scammell adds.)
The concern is that these countries’ regulatory systems for medics and prescribing may not be operated as rigorously as the UK’s. Nor are the doctors accountable to UK regulators if things go wrong, as they’re not necessarily registered with the General Medical Council (GMC).
The Mail has long campaigned about the dangerous over-prescription of opioids and benzodi-azepeines — and the failure to help patients innocently addicted to them. While that campaign has been vindicated by the announcement of an official review into prescription pill dependency, such drugs are too readily available online.
While there are no official figures on how many Britons are using these services to obtain opiates, David Grieve, a former mental health nurse who runs Over-Count, a charity that supports people dependent on such medications, says online prescriptions are the most popular purchasing option for people dependent on codeine-based
drugs, and he knows of hundreds who do this.
A similar issue is the ease with which patients can buy antibiotics online: the problem with opioids is that they’re seriously addictive and patients can easily overdose.
Experts at the official regulator, the General Pharmaceutical Council (GPhC), have become so alarmed by this burgeoning legal online trade in painkillers, antibiotics and mood-altering psychiatric medications, that they are proposing legal changes in the UK to try to curb it.
The GPhC’s chief executive, Duncan Rudkin, says: ‘We are concerned that patients may be able to access medicines that are not clinically appropriate for them from online services.
‘ Medicines are not ordinary items of commerce and must not be treated as such.’
The GPhC wants to ensure that anyone who wants to buy opiates and sedatives online must see their own GP first, to have their applications certified before they can import these drugs personally.
The GP will have to confirm that their patient really needs the drugs, and that their importation and use is monitored properly by the online service.
In effect, few if any will be able to obtain their GP’s approval — if they really do have a clinical need for such medications, the GP should be prescribing them.
The GPhC also proposes that online services should warn buyers if the doctors are based overseas.
Furthermore, it wants services to introduce systems to check that buyers really are who they claim to be, and to spot when people are making multiple purchases under different names but using the same addresses or bank accounts.
Such rules should not prove problematic to legitimate UK-based online pharmacies that employ fully qualified and accountable UK-based prescribing GPs who carefully monitor customers’ applications and contact their GPs when concerns arise.
Professor Helen Stokes-Lampard, chair of the Royal College of GPs, has welcomed the proposals. She told Good Health: ‘It’s incredibly worrying to hear reports of patients buying prescription medication from unverified online providers with minimal security checks, or from websites where the prescribers don’t have access to their full medical records.
‘It’s particularly encouraging to see the GPHC’s recognition of problems with websites operating outside the UK and who are exempt from inspection.
‘Without adequate safeguards, the safety of our patients is at serious risk.’
REGULAToRS in the UK are already seeking to tighten standards on online prescribing. But they can only rule over websites run by companies based in Britain that use UK-based GPs.
In fact, the GMC says it is investigating 21 UK-based doctors over allegations of malpractice in relation to online prescribing.
Now two have been referred to professional conduct hearings, while the other 19 are still under investigation. So far however, it has disciplined only one doctor, who was ‘given advice’ on improving the safety of his practice.
It appears, however, that the majority of doctors involved in this trade are based overseas — beyond the disciplinary grasp of the GMC.
A similar situation faces the Care Quality Commission (CQC), which inspects the companies that run medication-selling websites.
A spokesman explained: ‘If the prescriptions are not being issued by GMC-registered doctors, they may well not fall within the CQC’s scope of regulation either.’
The results of the 55 inspections that the CQC has performed on UK-based online prescribers since November 2016 themselves seem disturbing.
It states: ‘As of 28 February 2018, 43 per cent of the providers CQC inspected were found not to be providing “safe” care in accordance to the relevant regulations.’
However, the CQC cites this as evidence of ‘improvement’, as previous inspections found 86 per cent did not meet the regulatory requirements. And these, of course, are only the UK-based ones that use UK-based doctors.
one of those the CQC found to be a serious risk was HR Healthcare, the online service that sent Richard Breatnach the consignment of 126 high- strength dihydrocodeine tablets that brought about his death.
It was inspected by the CQC in January 2017 and a website it ran was closed down for six months ‘to protect patients’.
Inspectors found unsafe care, with national guidance ignored and patients at risk due to poor record-keeping — and a failure to share information with patients’ GPs, such as the doctor who would have warned that Richard should not be prescribed opiates.
This website was subsequently shut down, although HR Healthcare now operates another online service with a different name.
A spokesman told Good Health that in the wake of Richard’s inquest: ‘HR Healthcare reviewed its safety procedures and continues to do so regularly, and has since ceased dispensing privately issued prescriptions for dihydrocodeine and all other opioid medications.
‘As part of its ongoing safety review, HR Healthcare has also since implemented stricter controls on medications dispensed through the pharmacy.’
It is a consolation to know that our regulators may properly ensure that UK-based services using UK doctors must operate safely. But what of the others?
Admirable as the GPHC’s initiative may be, it will leave a gaping loophole, where drug-seeking customers can flock to legally permitted sellers operating in distant parts of the EU, where regulation may be perilously looser.
The Government could close that loophole. As the MHRA’s Lynda Scammel explained: ‘only Britain and a handful of other countries allow this practice. It’s banned in countries such as France, Spain and Italy.’
They have decided that online pharmacies which use doctors outside their borders should not send drugs to people who merely fill in questionnaires online.
Wouldn’t it make sense for ministers to copy our continental counterparts and ban this dangerous trade?