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GPs prescirbing drugs inappropriately

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  • 02-03-2015 1:21am
    #1
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭


    There's an increasing trend of students going to their GP and getting Ritalin, beta blockers and other drugs to help concentrate or get over the nerves of giving a presentation. What are the ethical implications of this? What are the views of the medical community on prescribing drugs as performance enhancers or beta adrenergic receptor drugs for enhancing presentation performance?


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    #2
    The other fella
    Registered Users Posts: 596 ✭✭✭The other fella


    Give me his name and business address and ill report him.


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    #3
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    I'm not giving out names over a forum and I'm sure it's against the rules. I just want to know is it wrong to prescribe things like beta blockers for presentation nerves?


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    #4
    [Deleted User]
    Posts: 8,647 ✭ [Deleted User]


    steddyeddy wrote: »
    I'm not giving out names over a forum and I'm sure it's against the rules. I just want to know is it wrong to prescribe things like beta blockers for presentation nerves?

    Ot necessarily.


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    #5
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    Does that go for prescribing Ritalin for concentration/studying for exams?


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    #6
    Winning Hand
    Registered Users Posts: 898 ✭✭✭Winning Hand


    Sounds like a gunner


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    #7
    Xeyn
    Registered Users Posts: 555 ✭✭✭Xeyn


    My cardiology professor suggested as long as there were no contraindications certain beta blockers should be considered for those with an anxiety about presenting. The Ritalin thing is very debatable. The risk profile would suggest it shouldn't be used for that purpose but I'm no expert an I would hope a proper consultation occurred with the prescribing doctor first.


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    #8
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    The other fella wrote: »
    Give me his name and business address and ill report him.


    I'm sure the IMC wouldn't accept a complaint in the form of
    I heard from some randomer on the interwebz that Dr Smith was prescribing Drug X for condition Y. Please strike him off.

    I'd say they'd look for a rather higher standard of evidence than that!


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    #9
    RobFowl
    Moderators, Science, Health & Environment Moderators Posts: 11,667 Mod ✭✭✭✭RobFowl


    Mod note
    Can you please quite some evidence to back this up?
    Rob


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    #10
    Mrs OBumble
    Registered Users Posts: 25,722 ✭✭✭✭Mrs OBumble


    locum-motion wrote: »
    I'm sure the IMC wouldn't accept a complaint in the form of

    I'd say they'd look for a rather higher standard of evidence than that!

    I'm kinda picking that the other fella didn't have reporting in mind when he asked for the address!




    OP, information about making a complaint about a doctor is found here: http://www.medicalcouncil.ie/Public-Information/Making-a-Complaint-/

    If it's people in your school who you think are getting drugs for the wrong reasons, then you should tell your concerns to the guidance counsellor, school nurse or student health service (if you're in college).


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    #11
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    RobFowl wrote: »
    Mod note
    Can you please quite some evidence to back this up?
    Rob

    Back up evidence that the GP in question is providing these thing or that that students are being prescribed things like beta blockers for nerves and valium ect. Well I have teaching responsible at a university and students (and other PhDs) tell me they got them off their doctor. Some GPs refuse to prescribe them but some even seem to give advice e.g "don't take valium take beta blockers as you'll be high during your presentation".

    It's not that I'm looking to report necessarily I'm just seeking opinion on the issue. Some GPs seem happy to prescribe them for the effects of adrenaline in presentations and some don't. I'm wondering what the rules are on the issue.


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    #12
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    Mrs OBumble wrote: »
    I'm kinda picking that the other fella didn't have reporting in mind when he asked for the address!




    OP, information about making a complaint about a doctor is found here: http://www.medicalcouncil.ie/Public-Information/Making-a-Complaint-/

    If it's people in your school who you think are getting drugs for the wrong reasons, then you should tell your concerns to the guidance counsellor, school nurse or student health service (if you're in college).

    I don't actually want to complain. I want to see what the opinion is on things like this.


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    #13
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    locum-motion wrote: »
    I'm sure the IMC wouldn't accept a complaint in the form of

    I'd say they'd look for a rather higher standard of evidence than that!

    Well I don't want to complain. Imo I seems relatively harmless (beta blockers) but I would love to know the opinion of posters here.


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    #14
    my3cents
    Closed Accounts Posts: 9,764 ✭✭✭my3cents


    OP might be having flash backs to something he read http://www.irishexaminer.com/lifestyle/features/humaninterest/students-turning-to-legal-stimulants-for-exam-edge-230722.html .


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    #15
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    my3cents wrote: »
    OP might be having flash backs to something he read http://www.irishexaminer.com/lifestyle/features/humaninterest/students-turning-to-legal-stimulants-for-exam-edge-230722.html .

    Em no. I'm talking about people I know using GP obtained prescriptions to get beta blockers. I can't believe you don't think students don't use these things for these purposes.


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    #16
    Mrs OBumble
    Registered Users Posts: 25,722 ✭✭✭✭Mrs OBumble


    steddyeddy wrote: »
    I don't actually want to complain. I want to see what the opinion is on things like this.

    So why did your original post say:
    steddyeddy wrote: »
    ... Who should I report this to if I know the GP in question?


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    #17
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    Mrs OBumble wrote: »
    So why did your original post say:

    Because I didn't think it through. My main question relates to the ethics of prescribing beta blockers ect for presentations and study aids ect. I think it's a fair question.


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    #18
    RobFowl
    Moderators, Science, Health & Environment Moderators Posts: 11,667 Mod ✭✭✭✭RobFowl


    steddyeddy wrote: »
    Because I didn't think it through. My main question relates to the ethics of prescribing beta blockers ect for presentations and study aids ect. I think it's a fair question.

    Mod note
    Could you edit your original post to reflect this please
    Rob


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    #19
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    RobFowl wrote: »
    Mod note
    Could you edit your original post to reflect this please
    Rob

    Done Rob thanks. It should make for an interesting debate.


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    #20
    Icemancometh
    Registered Users Posts: 854 ✭✭✭Icemancometh


    I think there's a qualitative difference between using beta blockers for performance related anxiety, and using methylphenidate to improve academic performance. I can't imagine ever prescribing a controlled medication for an off-licence use like that. I would imagine most off-licence prescribing was being done by specialists rather than generalists, but I'm sure it happens.


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    #21
    Nonoperational
    Registered Users Posts: 7,401 ✭✭✭Nonoperational


    Agreed.


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    #22
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    Icemancometh wrote: »
    I think there's a qualitative difference between using beta blockers for performance related anxiety, and using methylphenidate to improve academic performance. I can't imagine ever prescribing a controlled medication for an off-licence use like that. I would imagine most off-licence prescribing was being done by specialists rather than generalists, but I'm sure it happens.

    It happens but what are the ethics involved? Is it frowned upon?


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    #23
    MrCreosote
    Registered Users Posts: 2,320 ✭✭✭MrCreosote


    If you're looking for a clear distinction between using a beta blocker to treat a situational anxiety and using it as a performance enhancer/"doping" agent, you're not going to find it. Too much of a grey area.


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    #24
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    MrCreosote wrote: »
    If you're looking for a clear distinction between using a beta blocker to treat a situational anxiety and using it as a performance enhancer/"doping" agent, you're not going to find it. Too much of a grey area.

    No I'm not but looking for one. I'm just getting views on the subject. I mean if I go to a GP and ask for beta blockers because I don't like presentations should I be prescribed them. I don't think you could describe "feeling nervous during presentations" as pathology.


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    #25
    Icemancometh
    Registered Users Posts: 854 ✭✭✭Icemancometh


    steddyeddy wrote: »
    It happens but what are the ethics involved? Is it frowned upon?

    It's all so situational as to make discussion on it quite difficult. I've thought about this reply for some time and found it hard. You can very easily construct cases in your head where the meds have been prescribed inappropriately, and conversely, construct cases where they are appropriate. Of course, everyone frowns on the latter! Without knowing the particulars of each case (and to be clear, I'm not asking for any) it's hard to comment.


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    #26
    echo beach
    Registered Users Posts: 1,252 ✭✭✭echo beach


    steddyeddy wrote: »
    I mean if I go to a GP and ask for beta blockers because I don't like presentations should I be prescribed them. I don't think you could describe "feeling nervous during presentations" as pathology.

    The decision to prescribe or not is made after a consultation with the patient, which is confidential so you can't know the factors that may have been taken into consideration.
    Inderal, a beta-blocker, is licensed for the control of anxiety and anxiety tachycardia so it is perfectly reasonable to prescribe it for somebody who becomes anxious and suffers from an increase in heart-rate before and during presentations.
    The issue is when does the normal nervousness at having to make a presentation become a pathology, and that point will be different for different people. For some people "feeling nervous during presentations" is a most definite pathology, they hyperventilate or become physically sick and may even faint. There are other treatments but if they aren't contraindicated beta-blockers are very helpful in most cases. They shouldn't be used in asthmatics.


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    #27
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    echo beach wrote: »
    The decision to prescribe or not is made after a consultation with the patient, which is confidential so you can't know the factors that may have been taken into consideration.
    Inderal, a beta-blocker, is licensed for the control of anxiety and anxiety tachycardia so it is perfectly reasonable to prescribe it for somebody who becomes anxious and suffers from an increase in heart-rate before and during presentations.
    The issue is when does the normal nervousness at having to make a presentation become a pathology, and that point will be different for different people. For some people "feeling nervous during presentations" is a most definite pathology, they hyperventilate or become physically sick and may even faint. There are other treatments but if they aren't contraindicated beta-blockers are very helpful in most cases. They shouldn't be used in asthmatics.

    I'm a biochemist so I would have some knowledge of pharmodynamics and kinetics (not a lot). Tachycardia is a resting heart rate exceeding the norm IMHO. Anxiety during presentations is a situation that will bring about an adrenergic response which leads to increased heart rate. This rate arises though hormonal input not normal physiological conditions or as a result of pacemaker cells.

    I don't think it's suitable to correlate anxiety during anxiety generating situations (chased by lions ect) as tachycardia.


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    #28
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    I should add I think most of the "smart drugs" are obtained online and not prescribed.


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    #29
    Dingle_berry
    Registered Users Posts: 885 ✭✭✭Dingle_berry


    steddyeddy wrote: »
    No I'm not but looking for one. I'm just getting views on the subject. I mean if I go to a GP and ask for beta blockers because I don't like presentations should I be prescribed them. I don't think you could describe "feeling nervous during presentations" as pathology.

    How do you know that the students just 'don't like presentations' or are only 'feeling nervous during presentations' and not experiencing genuine pathological anxiety? Excessive anxiety is a recognised pathology.

    And if it's a concern of yours as a lecturer/teacher, what approaches can you take to ameliorate your students anxiety? I don't think taking measures to prevent prescribed medications would count.


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    #30
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    Dingle_berry wrote: »
    How do you know that the students just 'don't like presentations' or are only 'feeling nervous during presentations' and not experiencing genuine pathological anxiety? Excessive anxiety is a recognised pathology.

    And if it's a concern of yours as a lecturer/teacher, what approaches can you take to ameliorate your students anxiety? I don't think taking measures to prevent prescribed medications would count.

    Hey, I'm glad she's taking them IMHO opinion. It's none of my business what she takes but they definitely help her. It's the smart drugs I don't like. I originally thought they were being prescribed but they're not.


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    #31
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    I think this is similar to the phenomenon of the pushy patient demanding antibiotics and the passive doctor supplying them IMHO. It's a lot worse in the case of antibiotics IMHO but there seems to be an increase towards pushy patients making demands.


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