Voluntary undertaking

Prescribers and patients can enter into a voluntary undertaking agreement.  They agree to the patient only visiting a single doctor or practice and pharmacist for controlled and monitored medicines such as benzodiazepines, opioids or other specified medicines.

The scheme is unique to the ACT and promotes the safe use of controlled medicines. It enables you to support patients who may be drug-dependent.

Each voluntary undertaking is valid for 6 months and can be cancelled at any time or renewed if required.

Scheme protocols

Before negotiating a voluntary undertaking doctors should:

• encourage patients with known or possible excessive benzodiazepine, opioid or other drug use to enter into an agreement
• understand that patients can't be forced to sign an agreement, but consider not prescribing if the patient won't participate
• understand the immediate medical safety of the patient is a primary concern when deciding whether to prescribe
• check with the patient's chosen pharmacy that it wants to participate in the scheme.

Informed consent

The patient should know that:

• there are potential dangers of sudden reductions or stopping use of benzodiazepines or opioids
• requests for prescriptions can be refused if the agreement is breached
• they can cancel their agreement at any time through their identified doctor
• the agreement is valid for 6 months unless cancelled by you or the patient
• a third party witness needs to sign the agreement to ratify the signatures of both doctor and patient.

Signing a voluntary undertaking

1. Download and sign the voluntary undertaking form. You may still require an approval to prescribe a controlled medicine for medicines relating to a voluntary undertaking.
2. Provide a final signed copy to the patient.
3. Keep a copy in the patient's file.
4. Send a copy, clearly marked 'confidential' to the Health Protection Service via fax 05124 9309 or to Locked Bag 5005, Weston Creek ACT 2611.
5. Mark undertakings and associated documents as 'confidential' and take measures to ensure there is no unauthorised access to the files.
6. Doctors should consider encouraging patients to participate in a gradual, supervised reducing regimen, where possible.
7. Consider referring the patient to an alcohol and drug service for additional support and joint case management.

If any alterations are made to the contract, you need to notify the Health Protection Service on 02 5124 9208 or hps@act.gov.au

You should ensure:

• only pharmacists in your pharmacy are aware of the patients who have agreed to a voluntary undertaking
• the prescription has been annotated with your nominated pharmacy name.

Breaches of a voluntary undertaking

If a pharmacist identifies that a patient is seeing a doctor or pharmacy other than those identified in the agreement:

• the patient should be referred back to the identified doctor or pharmacy
• the identified doctor and pharmacy should be notified.

If you're a doctor and an agreement is breached, you should discuss the breach with the patient and consider:

• the underlying problems to help the patient to resolve them
• the patient's safety
• re-negotiating the voluntary undertaking to include other conditions such as counselling, daily collection of medications from doctor or pharmacy or a reduced daily dosing regimen
• liaising with the ACT Alcohol and Drug Services.

If patients refuse to re-negotiate their agreement, their immediate medical safety is a primary concern when deciding whether to continue prescribing.

After repeated breaches a doctor:

• can decide to cancel the undertaking
• can refuse to prescribe benzodiazepines, opioids or other specified medicines
• can refer the patient to an alcohol and drug service
• should ensure the patient is aware of the dangers associated with suddenly stopping benzodiazepines.

Objectives of the scheme

The scheme aims to:

• encourage continuity of care
• promote safe and controlled prescribing and use of benzodiazepines, opioids or other specified medicines
• minimise harm associated with benzodiazepine and associated alcohol or other drug use
• assist doctors to achieve the best possible health outcomes for patients using alcohol and other drugs
• reduce the incidence of 'doctor shopping' by patients.
• where viable, enlist the patient onto a gradual, supervised reducing regimen.

Health Protection Services provides updates on voluntary undertakings to pharmacists and medical practices in the ACT and Queanbeyan region.

Contact us on 02 5124 9208 or hps@act.gov.au for more information if your workplace isn't receiving these updates.