The Pharmaceutical Journal
Vol 276 No 7393 p346
25 March 2006

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· EPS
· Public health
· Supervision
· Assisted dying
· Paracetamol
· FDCs
· Branded prescribing
· Methadone mixture
· Incontinence products
· CPD
· The Society (2)

Letters to the Editor

Branded prescribing

Patient safety or industry pay day?

From Mr A. Dickman, MRPharmS

I understand William Horsley’s concerns about motives behind the call for brand prescribing (PJ, 11 March, p293) but through the mist of this cynical world, I hope he can see that it is the patient that will benefit from such a recommendation. There is a price difference between some of the leading brands of strong opioids to others, but the cost of a serious error far outweighs this. In his letter, Mr Horsley implies that a call for branded prescribing by the Royal Pharmaceutical Society’s Practice Committee and those members who advise it, could be due to the influence of the larger pharmaceutical companies that manufacture the recognised brands of strong opioids. Branded prescribing of strong opioids is being recommended as a simple, yet effective method of ensuring a prescriber’s intentions for this class of drug are clear, thereby avoiding a potentially fatal outcome. It is for patient safety, not for the pharmaceutical industry, that branded prescribing is being called. Once a patient has been stabilised on a particular brand of strong opioid, it is recommended that this treatment is continued, whether it is with a recognised product, or a newer generic version. Mr Horsley assumes that the recognised brands will be prescribed over the others. I argue that this will not be the case. Indeed, in my own locality, the recommended modified-release morphine product throughout the primary care trust and hospital is not the so-called brand leader.

A prescription written in generic format, such as “morphine sulphate m/r capsules” or “fentanyl patch 25mcg/hr” leads to ambiguity. What is the prescriber’s intention? Zomorph, MXL or Morcap? Is a reservoir patch intended, or the newer matrix patch? Obviously, in the case of morphine, the dosing schedule would aid the pharmacist, but I would hope that the majority of pharmacists would question either prescription. There have been rare reports of pharmacists dispensing MXL to fill a generic morphine prescription for a twice daily dosing schedule. There are several other rare incidences of strong opioid product confusion, some potentially more dangerous than others, but fortunately none (to my knowledge) fatal. To err is human and errors with medicines will continue to be made. However, if we can make the system less ambiguous and simpler to use, surely this can only be a good thing? Do we, as a profession, have to wait for that one fatality before we do anything? How many rare occurrences that could lead to fatalities are acceptable?

For completeness sake, I can confirm that I have received assistance to attend courses and conferences from several pharmaceutical companies, including Boehringer Ingelheim, Cephalon, Janssen-Cilag, Link, Merck Sharp Dohme, Napp, Pfizer and Viatris.

The sceptical readers will have now completely switched off after the above statement. For those of you still with me, working daily in the palliative care environment places me in a position to be able to judiciously extrapolate and interpret the current situation with regard to branded prescribing. A quote nicely brings this letter to a close: “Medical practitioners should regard the recommendations of consensus development conferences as useful reference tools; not the rulings of philosopher kings, but the attempt of thoughtful people to share their knowledge, albeit imperfect, with other people.”¹

Andrew Dickman
Specialist Principal Pharmacist
Palliative Care Team
Whiston Hospital, Merseyside

Reference

1. Tong R. The epistemology and ethics of consensus: uses and misuses of “ethical” expertise. J Med Philosophy 1991;16:409–26.

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