Doctors overprescribed my medication - Germany

Told to return unused amount of large prescription

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pigalle
I need to make a long international flight next week, but I have a fear of flying. I've been prescribed benzodiazepines to deal with this in the past, so saw a psychiatrist on Friday to see if this would be an option in Germany. The doctor I had an appointment with was really helpful. We discussed a range of short and long-term options, and he agreed to a Tavor (lorazepam) prescription to deal with the immediate situation.

What I found strange was the amount of tablets that he prescribed. I needed 4 mg in total (1 mg before take-off and another before landing in both directions), but the prescription was for 50 x 1 mg tablets. He said that this was the smallest package available, and that I was to give him the 46 unused tablets as soon as I came back. He could then hand them out to other patients.

I've been given 20 x 0.5 mg packages of lorazepam before in the UK, and from looking online, it seems that smaller packages are also available in Germany. Maybe he just didn't know that? And can doctors here really give out medications directly? I don't think this is possible in the UK; I always thought pharmacists had an important role in checking prescriptions. Without a pharmacy, isn't it too easy for doctors to mis-prescribe drugs or even use them themselves?

I have no real reason to doubt his intentions; he was a nice, seemingly-normal man in a busy practice. I'm just curious to know how I ended up with so many addictive pills, and if German doctors handing out medications themselves is standard practice. Any thoughts?

Thanks!
2B_orNot2B
Medicines in Germany are normally packed, apart from marketing samples, in 3 sizes (N1, N2 & N3) with the largest sometimes intended to be the hospital or clinical package. N3 packs may also be prescribed to patients with long-term needs or chronic conditions.

It is quite common for doctors in private practice in Germany, who must conform with strict quarterly practice prescribing budgets, to pass on marketing sample packs to publicly insured patients of limited means. The co-payment amounts which apply to some prescription drugs can, in some cases, put them out of the reach of poorer patients. I think it is quite feasible that the psychiatrist you consulted knows of other patients on his/her books who could benefit from any such surplus prescription drugs.

The situation for hospital doctors is managed and controlled quite differently, with their prescriptions being filled by the institution's pharmacy. This becomes obvious to anyone being discharged who is in need of prescription medicines, as the amounts they will issue are strictly limited to cover the period until the patient can visit their own GP, clinic or other ambulatory practice.

I think I would simply take as many of the lorazepam tablets with you as you feel comfortable taking and then return any surplus to the psychiatrist without being overly concerned about it.

Happy landings!

2B
gemini
That would so not wash in the US system...so much room for abuse.
Oblomov
It is quite common for doctors in private practice in Germany, who must conform with strict quarterly practice prescribing budgets, to pass on marketing sample packs to publicly insured patients of limited means. The co-payment amounts which apply to some prescription drugs can, in some cases, put them out of the reach of poorer patients. I think it is quite feasible that the psychiatrist you consulted knows of other patients on his/her books who could benefit from any such surplus prescription drugs.
I suppose that's the reason behind this rather strange request. As doctors who do not stay within the allocated budgets get financially penalized it may be less of a concern for the other patients' co-payments than for his own wallet, though.
fraufruit
I thought the drug companies provide doctors with "marketing samples". My doc has gazillions.

I once tried to give him a left over prescription that didn't agree with me and he said he couldn't dispense it to other patients.

Interesting.
DDBug
Wait, so did you pay for this big package yourself as a private patient or the surcharge as a kasse patient? Isn't the surcharge also proportional to the price of the medicine?

I've had the pharmacy open packages and give me smaller amounts of medication, but never had a doctor request I pay for and then bring him extra meds. Sounds really odd to me.
Metall
I would like to add that *your* health insurance will then pay for the medication
for random other people.
Also, the large amount of Tavor will create the impression you are taking this
long term.

This whole deal could theoretically have an effect on your premium if you carry private.
Even if it doesn't, I don't quite like this.

Theoretically, your psychologist could even peddle the pills on the street
(not that I think he will), and nobody would be the wiser.

I'd say go to the pharmacy and insist on the smallest package. The insurance
will notice that. (And yes, I'm from the medical business.)
LostinLuneburg
A bit of a hijack:

I once tried to give him a left over prescription that didn't agree with me and he said he couldn't dispense it to other patients.
So what are you supposed to do with left-over medications? Where I'm from, we were supposed to return them to pharmacies/clinics as throwing them in the regular garbage can result in environmental damage when biologically active compounds seep into groundwater. There were also charities that were licensed to accept prescriptions and give away medicine to the needy. What am I supposed to do with left-overs here in Germany??
kato
What am I supposed to do with left-overs here in Germany??
Federal Health Ministry recommends putting them in Restmüll to be burned*. If you don't want to go that route many pharmacies also collect them, as well as the various municipal options for Schadstoff.

* since 2005 no untreated trash may be dumped in Germany.
Traunstein
What am I supposed to do with left-overs here in Germany??
I just return mine to my hausartz.
LostinLuneburg
Thanks kato and Traunstein!! I had been wondering about that, and no one I asked seemed to know
kato
no one I asked seemed to know
That's because everyone in Germany seems to be hoarding any prescription and OTC medicines they have left over for future self-medication. Part of that evolved due to the copayment schemes since 2004, a large part of it is traditional among Germans.
fraufruit
That's because everyone in Germany seems to be hoarding any prescription and OTC medicines they have left over for future self-medication.
Many Amis do the same. I imagine that people everywhere do.

I have a little basket full and weed out the expired stuff every 6 months or so.
robinson100
Yes, most people have a little supply of "drugs" at home from past ailments - I see absolutely nothing wrong with it.
If something is wrong with me, I will generally try whatever I have a thome and if nothing works, I will go and see the Doc - he generally has more important things to do than see me with my tennis arm/lost voice/twisted ankle so I only go to see him when I don´t know what else to do.

As for having been asked to give any surplus of a prescription to the Doc, well it might or might not be 100% according to the rules, btu I have to admit to having been on the receiving end of some "extra" blood enhancement tablets some years ago - the Doc simply gave me a handful of blister packs, told me to try them and if they worked, he would give me a prescription for more - they did, and I got one.
I see it as not really a problem, but rather a way of saving the health services some money.
kato
That's the simple stuff though. I'm more talking about the stuff that can easily give you kidney failure (Voltaren), psychotropic episodes (Benzoes) or just kill you when wrongly dosed. Plenty of that in the personal hoards too.
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