Baclofen prescribing doctors in the UK

[Otter]

Baclofen prescribing doctors in the UK

Prescribing

Hi

The GMC guidelines do not restrict doctors to prescribing at 100 mg. An email to them will get a response that they are obliged to look at information beyond what is on the box. I think it is professionally improper to refuse to prescribe on the advice of a specialist like Chick.

Change surgeries!

Cheers

[Virgil]

Baclofen prescribing doctors in the UK

scot98;890850 wrote: This is interesting as I was discussing the benefits with seeing Prof Chick with a friend recently. I did email him and he did say he was happy to see me in Edinburgh, great I thought until I saw my GP with an article on Baclofen and he was not in any way open to prescribing it.....even under Prof Chick's guidance!

Hi scot,

I have highlighted a section in blue above. This is because it is my understanding that GPs are not at liberty to prescribe baclofen for alcohol-related issues as this would constitute using this medication 'off licence', if I am using this term correctly. The NHS Primary Care Trust (PCT) has overall say in these matters - please correct me if you know otherwise. I had this very discussion with my GP many months ago so I'm relying on my memory, which is not what it used to be!

Private medical practitioners are not constrained by NHS PCTs - again, that's my understanding. Perhaps you could pursue this with Prof Chick?

All the best.

V.

[scot98]

Baclofen prescribing doctors in the UK

Virgil;891730 wrote: Hi scot,

I have highlighted a section in blue above. This is because it is my understanding that GPs are not at liberty to prescribe baclofen for alcohol-related issues as this would constitute using this medication 'off licence', if I am using this term correctly. The NHS Primary Care Trust (PCT) has overall say in these matters - please correct me if you know otherwise. I had this very discussion with my GP many months ago so I'm relying on my memory, which is not what it used to be!

Private medical practitioners are not constrained by NHS PCTs - again, that's my understanding. Perhaps you could pursue this with Prof Chick?

All the best.

V.

Hi Virgil,

Many GP's prescribe off label, mainly for children from what I gather. I do believe private Dr's do not have the same constraints as those governed by NHS primary care trusts.
My personal gripe is my GP said and to quote " WE will not be prescribing you Baclofen" This was before he had even read the article, and I doubt he has done, sad but probably true. He did not appear at all interested in the Fact that my consumption had dropped, no blackouts,mood has been stable since starting Naltrexone and that my restless legs problem has not been an issue, yet I had been prescribed a fairly new drug to treat Parkinsons disease and the long term effects are not known! what's worse is he never asks about this problem. I used to respect him but not now, people seem to believe the NHS is there for all there health problems.....................NOT by a long way!
It just paints a really sad picture to me, I am SO glad we have the internet and MWO and other sites for support and information and ultimately the opportunity to buy medication for our wellbeing which was previously only available through a Doctor...........Oh how times have changed and I am so grateful in that respect.
I have concerns about buying medication over the internet and the lack of control who buys the stuff but hey I am very grateful I have the choice to do so.

I have decided I do not wish any NHS or GP/ private doc involvement from now on.

Best wishes to all

[Virgil]

Baclofen prescribing doctors in the UK

scot98;892102 wrote: Many GP's prescribe off label, mainly for children from what I gather. I do believe private Dr's do not have the same constraints as those governed by NHS primary care trusts.

Hi scot,

It's interesting what you said above. My GP categorically stated that she was not in a position to prescribe baclofen because the PCT would not permit her to do so. I guess it's possible that different PCTs may take a different stance regarding off-label prescribing but that seems odd to me. If you are in discussion with Prof Chick, it would be good to get his take on this.

All the best.

V.

[scot98]

Baclofen prescribing doctors in the UK

Hi Virgil,

I know a few GP's and next time I get a chance I will ask one what the situation is with off-label prescribing and whether it varies between different PCT's. I thought GP's could prescribe any drug unless it's indicated that it is for specialist use only, for example, Venlafaxine was previously prescribed by GP's but now you can only be prescribed it by a Psychiatrist, if I remember rightly.

Best wishes

[Brave Hearted]

Baclofen prescribing doctors in the UK

Hi Scot not read this thread for a while and just read your experience with your Gp . Blood and Boiling comes to mind ! Prof Chick is happy to continue prescribing the baclofen, I suspose he will contact my GP if I want and see what respnse he gets. I dont think a private script is that expensive and the main benefit is that it is prescribed by a professional and I know what I am getting , which is not always the case online. I am away next week and then going up to see him so I will put a post up after my visit ! I feel quite excited !

BH

[Otter]

Baclofen prescribing doctors in the UK

When they started using Baclofen to treat alcoholism in France doctors became upset that they were being overrun with patients requesting prescriptions.

I think doctors who prescribe should be making this service known so here goes.

Dr. Susan Cooper of Fenwick Road Surgery, Giffnock, Glasgow, prescribes Baclofen above 100 mg per day for alcoholism. The Royal Alexandra Hospital in Paisley treats alcoholism with Baclofen as does Dykebar Hospital in Paisley. If you live in those areas you can get treatment on the NHS through a referral by your GP.

Just don't tell anyone I said so.

[TracyA]

Baclofen prescribing doctors in the UK

Otter;1086802 wrote:
There, I have "outed" a doctor. Hope she gets lots of calls.

Otter, thank you! :l

[Otter]

Baclofen prescribing doctors in the UK

Why is everyone who gets a prescription protecting their doctor? They have a duty of confidentiality to you. You don't have a duty of confidentiality to them....

Tracy, that was quick. I did out our doctor. Sorry for editing that out.

[spacebebe01]

Baclofen prescribing doctors in the UK

When I asked my doctor in Liverpool he told me that in no way would he consider prescribing for me off-licence because "if anything goes wrong when a drug he prescribed is being used for the purpose it is licensed for then its the drug company that gets sued, but if anything goes wrong when he prescribes off-licence the its him who gets sued" in other words he is not prepared to take any risks himself for his patients.

[Otter]

Baclofen prescribing doctors in the UK

Our GP initially refused to go above 100 mg or even up to that level. She then agreed to go up to 100 mg when advised to by Jonathan Chick. Now she has been advised by a new doctor to go above that level she has done so.

It is about knowledge and experience using the medication and assessing the risks and benefits. Professional negligence can result from failing to prescribe properly and failing to take into account new developments in medicine.

The law on the subject in England, which is the same as all other common law countries and the US is set out in a case called Bolitho. You can refer to this when you talk to your doctor. A doctor has to look at the risks and benefits of Baclofen and compare them with the risks of allowing a patient to remain alcoholic.

Bolitho is a House of Lords decision on the standard of care in negligence cases against doctors. The House of Lords in 1957 in a case called Bolam said that doctors could not be held negligent if they followed practices which were also followed by a responsible body of experts. That decision was often criticized as it suggested that whatever doctors generally do for patients, so long as they all do it or there are some responsible doctors who say the practice is acceptable, there is nothing a patient can do about it. If you become ill because your doctor does not follow a new treatment the doctor could not be held responsible for what happens to you.

In other words, in the case of alcoholism, a doctor could not be criticized for following the accepted treatments for alcoholism.


The House of Lords in Bolitho changed that by reinterpreting Bolam. Here is what they said:


"...in cases involving, as they so often do, the weighing of risks
against benefits, the judge before accepting a body of opinion as
being responsible, reasonable or respectable, will need to be satisfied that, in forming
their views, the experts have directed their minds to the question of
comparative risks and benefits and have reached a defensible conclusion on the
matter. There are decisions which demonstrate that the judge is
entitled to approach expert professional opinion on this basis. For example, in
Hucks v. Cole [1993] 4 Med.L.R. 393 (a case from 1968), a doctor
failed to treat with penicillin a patient who was suffering from
septic spots on her skin though he knew them to contain organisms
capable of leading to puerperal fever. A number of distinguished
doctors gave evidence that they would not, in the circumstances, have
treated with penicillin. The Court of Appeal found the defendant to
have been negligent. Sachs L.J. said, at p. 397:
"When the evidence shows that a lacuna in professional practice exists by
which risks of grave danger are knowingly taken, then, however small the risk, the
court must anxiously examine that lacuna—particularly if the risk can be easily and
inexpensively avoided. If the court finds, on an analysis of the reasons given for
not taking those precautions that, in the light of current professional
knowledge, there is no proper basis for the lacuna, and that it is definitely
not reasonable that those risks should have been taken, its function is to state that
fact and where necessary to state that it constitutes negligence. In such a case the practice
will no doubt thereafter be altered to the benefit of patients."
On such occasions the fact that other practitioners would have done the same thing as the
defendant practitioner is a very weighty matter to be put on the
scales on his behalf; but it is not, as Mr. Webster readily conceded,
conclusive. The court must be vigilant to see whether the reasons
given for putting a patient at risk are valid in the light of any
well-known advance in medical knowledge, or whether they stem from a
residual adherence to out-of-date ideas."


It is interesting that, having heard Dr. Ameisen, doctors at the McLean Medical School at Harvard University asked him to write up a prescribing schedule for Baclofen to be used immediately. I can only think that they were intelligent doctors who were enlightened about their ethical and legal responsibilities to their patients.


That is the law so when you go to your doctor with articles about Baclofen and stories from here about its success take this statement of the law and maybe then they will start to listen...and maybe their PCT will start to listen as well.