GPs need a means to easily and accurately identify prescription shoppers, according to editorial comment in the current issue of The Medical Journal of Australia.

Dr Max Kamien, Emeritus Professor in the Discipline of General Practice at the University of Western Australia calls for a reintroduction of the HIC's now defunct doctor shopper line, which allowed doctors to identify doctor shoppers within 30 seconds.

But the telephone line was cancelled in August 2002 because of budget and privacy concerns. The new system takes 7-10 days to identify prescription shoppers. It places the legal standing of the doctor shopper above that of the doctor and puts the doctor shoppers' fragile lives at greater risk than is necessary.

"The necessary legislation and technology to reactivate the previously effective dedicated doctor-shopping line is already in place. There is no logic in further governmental delay in its reintroduction. Doctors want it and need it," Dr Kamien said.

According to the Health Insurance Commission (HIC), a 'prescription shopper' is a person who has, in a three month period, been supplied prescription drugs by six or more different prescribers, or has been prescribed a total of 25 target pharmaceutical benefits or 50 or more pharmaceutical benefits in total. These broadened criteria have identified 22,000 doctor shoppers.

Dr Kamien said people doctor shop to get benzodiazepines and opioid analgesics either for their own use or to swap or sell. Some see up to two different GPs a day for every working day of the year.

"Reputable and dedicated doctors who espouse a philosophy of harm minimisation can face disciplinary proceedings if they are accused of prescribing excessive amounts of drugs of addiction. Strangely, prescription shopping is not illegal, and doctor shoppers are not subject to the same legal constraints as those who prescribe for them."

Dr Kamien said most doctor shoppers are between 20 and 40 years old, and present with transparent stories of severe pain, stress, insomnia, or a request for benzodiazepines to help them withdraw from opiates or alcohol. They are usually much more medically sophisticated than the average patient and are quite explicit about the medication they want.

In this issue of the Journal, Martyres and colleagues, who analyse doctor shopping behaviour of 202 young people, see doctor shopping as a cry for help and an opportunity for GP intervention. But, they say, it is seen more as an economic problem than a medical problem. Doctor shopping costs the PBS more than $30 million a year.

Dr Kamien says doctor shopping is an ethical problem for the medical profession, adding that half the prescriptions for doctor shoppers are written by 7.5 per cent of Australian GPs who mostly practice in one of ten residential postcode areas.

CONTACT     Prof Max KAMIEN                 041 993 0660 / 08 9385 8685 (h)

                  Judith TOKLEY, AMA,           0408 824 306 / 02 6282 4307 (w)