Monitoring prescriptions across four drug groups
Addictive medicines must be prescribed with caution. For this reason, we monitor how doctors and dentists prescribe these medicines.
If a doctor’s or dentist’s prescribing pattern causes concern, we may initiate a supervisory case.
The purpose of the supervision is to support doctors and dentists in prescribing addictive medicines safely.
We focus on prescriptions across these five selected drug groups:
- Opioids
- Benzodiazepines
- Certain types of sleeping medication (hypnotics)
- Central nervous system (CNS) stimulants
- Products containing cannabis
Where do we get the information from?
All pharmacies report filled prescriptions to a central registry, which allows us to extract data on how individual doctors and dentists prescribe these medicines both to patients and to themselves.
We also receive data on prescriptions issued to pseudo-CPR numbers (temporary identification numbers), which doctors or dentists may use to prescribe medicines that need to be available in the clinic. This allows us to monitor the volume of medicine that the healthcare professional orders for use in their own practice.
Data from pharmacies includes:
- The patient’s name and CPR number (civil registration number)
- The prescribed product
- Strength and quantity of the product
- Information on when the prescription was dispensed and at which pharmacy
We do not receive information regarding the indication for the prescription, any diagnoses the patient may have or other details from the patient record.
How our prescription supervision works
The supervision of prescriptions covers three main areas. We review:
- Prescriptions to patients
- Prescriptions to immediate family and close relatives
- Prescriptions issued to one's own CPR number
Prescriptions to patients
Several times a year, we conduct a screening within each group of addictive medicines. For each drug group, we review the doctors and dentists who prescribe large volumes of these medicines to the highest number of patients. During the screening of each drug group, we review a fixed number of doctors and dentists.
It is important to emphasize that being in the group of professionals who prescribe the largest volumes of addictive medicines does not automatically imply a failure to comply with professional standards when prescribing.
Any information from previous supervisory cases is included in our assessment of whether there is a risk to patient safety.
A number of cases are closed after the initial review of the selected doctors and dentists. This may happen for instance if we have information that a doctor works at a substance misuse treatment center and the prescribing pattern aligns with their specific job role.
If, after initial review, we decide to investigate a case further, we typically request a statement from the doctor as well as relevant patient record material concerning a number of specific patient cases. We will often obtain an assessment of the material from a medical specialist within the same specialty as the doctor/dentist in question. If we assess that the treatment overall complies with professional standards and raises no concern for future patient safety, we inform the doctor that the case has been closed.
The volume of addictive medicines prescribed is not in itself decisive. What matters is whether the treatments have been conducted with care and conscientiousness (cf. the Danish Health Law / Authorisation Act).
If we assess that there is cause for concern, the same regulatory steps apply as in other supervisory cases concerning the professional competence of healthcare personnel. In most cases, this involves intensified supervision or an order requiring the healthcare professional to prescribe addictive medicines safely and responsibly.
If the doctor/dentist does not alter their clinical practice, we may restrict their prescribing rights. However, this is only done in rare cases.
Read about professional competence cases and types of sanctions (in Danish only)
Prescriptions to immediate family and close relatives
As a general rule, a doctor or dentist should only prescribe addictive medicines to close relatives under exceptional circumstances. If a doctor or dentist appears in our screening, we therefore also examine whether there are indications that the individual has prescribed to e.g. family members or close relatives.
Prescriptions issued to one's own CPR number
We also review the doctors and dentists who prescribe the largest volumes of addictive medicines to themselves, i.e. to their own CPR number. In these cases, we supervise the health professional’s fitness to practice
In fitness to practice cases, the objective is to ensure that doctors and dentists do not repeatedly prescribe these medicines to themselves and thereby risk developing dependence, which could render them unfit to work due to being impaired by the drug in question.
When evaluating these cases, we look at the medicines prescribed, doses, frequency, and whether other doctors/dentists are prescribing the same medicines to the individual. We also include any previous supervisory cases in our assessment.
If the prescriptions cause concern, we request that the doctor/dentist submits a statement or attends an interview with us. It may also be necessary for the individual to provide urine samples over a period of time. However, only a small minority of cases originating from our prescription monitoring result in sanctions against the doctor or dentist.
Read about fitness-to-practise cases and types of sanctions (in Danish only)