A PHARMACIST caught dispensing 700 pills containing addictive and dangerous drugs to a single patient over three months has been suspended.
Michael Azzer was working 70 hours per week at Christopher Discount Chemist in West Gosford during 2017 when it was investigated, along with an adjoining medical practise.
Mr Azzer was found guilty of over-prescribing addictive drugs to nine patients, including one patient, referred to as 'Patient A', who received 1100 pills from the pharmacy between July 24 and October 20, 2017.
Of those, Mr Azzer filled scripts for 700 tablets.
Over-dose
During the course of those 88 days, Patient A received an equivalent of more than 35 times the recommended daily dose of oral morphine for non-cancer pain.
The same pharmacy doled out 24 prescriptions for three different types of benzodiazepines to Patient A at the same time, sometimes dispensed at intervals as short as two days.
Mr Azzer variously prescribed large amounts of dangerous drugs to the nine patients, including a range of opioids such as oxycodone, fentanyl, morphine and alprazolam, as well as benzodiazepines, often in combination.
Pharmacists including Mr Azzer gave another patient, known as 'Patient C', more than 1700 oxycodone tablets or capsules in various strengths.
In a 32-day period Mr Azzer alone dispensed a total of 27,480mg of oxycodone to Patient C amounting to an average daily dosage more than four times the prescribed dosage, along with 50 tablets of oxazepam, a benzodiazepine.
Dr's say-so not enough
He told a NSW Tribunal that he did vet patients' dispensing histories, but in each case was "reassured" by the prescribing doctor as to the need and therapeutic purpose for the dose prescribed.
One of the doctors he checked in with was Urmila Sriskanda, who also came to the attention of authorities during the investigation.
The NSW Medical Tribunal has described the prescribing of Dr Sriskanda, as "gross, dangerous, and reckless".
Dr Sriskanda was prescribing drugs like oxycodone and benzodiazepines to known addicts in large quantities, higher frequencies, and for longer periods than appropriate.
At one point, Dr Sriskanda was writing scripts for addictive drugs for at least 16 people who she knew, or ought to have known were drug dependent because they were all on the NSW Opioid Treatment program.
As a result of that behaviour Dr Sriskanda was de-registered for two years.
Mr Azzer was required to do more than just check in and take whatever answer he was given at face value, the NSW Administrative Tribunal has found.
'Use your judgement'
It was his responsibility to use his independent judgement to independently evaluate whether the explanations he was being given were credible.
A pharmacist operating at "the general standards required" would have become "highly attuned and attentive" to the potential risks of dispensing such large quantities of drugs, the tribunal found.
"It is not sufficient merely to make an enquiry of the prescribing doctor and to accept at face value whatever the practitioner told the pharmacist," the panel of four tribunal members found in their written judgement handed down on Wednesday, June 5.
"That is so, particularly, if the explanation was of dubious veracity. By his own admission the Respondent did not apply any independent judgement as to whether the drugs which were being prescribed at vast quantities and, in many cases, following a pattern of prescription every two, three or four days by various practitioners could be misused."
Gaps in knowledge
Mr Azzer said at the time, he was at an early stage of his career in Australia, and there was a gap in his knowledge. He did not believe he could reject a direction from a medical practitioner to supply medication.
He told the tribunal he now understood that he could refuse to supply medication on a prescription, even if he had spoken to the doctors and had confirmed their instructions.
The tribunal accepted he had since fundamentally changed his practice and now appeared to comply with his obligations as a registered pharmacist.
Mr Azzer, who now works at one of two pharmacies in a town called Junee in the Riverina region of NSW, has had his licence suspended for three months.
