Tackling inappropriate prescription practices for weight loss drugs

A critical issue within the pharmaceutical sector has been highlighted by the MHRA’s investigation into the improper prescription of Wegovy. The misuse of prescription medications like Wegovy and Ozempic, compounded by a lack of stringent clinical procedures, underscores the urgent need for heightened accountability. Healthcare professionals, particularly pharmacists, have a duty to uphold rigorous clinical standards to safeguard patients.

Gaps in accessibility oversight

During my pregnancy last year, I explored the accessibility of GLP-1 receptor agonists (GLP-1RAs) - medications primarily designed to manage type 2 diabetes, but also prescribed for weight loss. Disturbingly, I found that online pharmacies offered these drugs with minimal safeguards, even against their well-documented risks during pregnancy. The ease with which these medications could be obtained raised serious concerns about inadequate measures to prevent misuse. Such vulnerabilities reveal systemic weaknesses, especially when drugs like Wegovy should only be prescribed under close clinical supervision.

A significant concern is the prescription of Wegovy to patients for whom it is neither safe nor appropriate. Across the UK, incidents of gastrointestinal complications have surged, with the MHRA recording 5,073 adverse reaction reports. This reflects a worrying pattern of careless prescribing practices. Healthcare professionals must prioritise clinical accountability to minimise risks associated with drugs that can lead to severe health consequences when misused.

Cultivating peer accountability

Unlike nursing and other medical professions, the pharmacy sector lacks a robust framework for peer accountability. Introducing such mechanisms is essential to ensure appropriate prescribing practices. Pharmacists and clinicians must report instances of improper prescribing to uphold professional integrity. Increasingly advertised are job roles where pharmacists are expected to approve up to 20 weight loss patients' prescriptions an hour - a shocking expectation - assessing this many patients appropriately would be a challenge in an entire day, let alone an hour, and suggests the incoming crisis we could see relating to these drugs!

Pharmacy teams should foster an environment where cases can be openly discussed, practices evaluated, and decisions aligned with the highest standards of patient care. By encouraging accountability and transparency among peers, the profession can create a culture of ethical responsibility.

The importance of clinical documentation

The absence of peer accountability is further aggravated by poor clinical documentation in some pharmacy settings. Unlike GPs and nurses, pharmacists often lack comprehensive systems to document assessments and follow-ups for prescriptions such as Wegovy. This gap not only exposes pharmacists to legal and professional risks, but also jeopardises patient safety.

Detailed clinical records are vital for protecting both patients and practitioners. Recording every consultation, including those conducted online, should be a priority. Such records enable pharmacists and other healthcare providers to access essential patient information, facilitating better-informed treatment decisions and continuity of care.

Managing the introduction of Mounjaro

The recent NICE approval of Mounjaro for adults with poorly controlled type 2 diabetes, particularly those unresponsive to treatments like metformin, presents additional challenges. Although it has not been approved for NHS use solely as a weight-loss treatment, the rising demand for such drugs could lead to supply shortages. This risks depriving diabetes patients of essential medication.

Mounjaro, like other GLP-1 drugs, carries potential side effects, including nausea, vomiting, dehydration, and hypoglycaemia – especially when misused or taken alongside other diabetes treatments like insulin. This raises the likelihood of increased A&E admissions, further straining emergency services.

Pharmacists will play a pivotal role in mitigating these risks by ensuring that Mounjaro is used safely and appropriately. However, they face challenges such as supply chain constraints and the need to educate patients on proper usage. Pharmacists will need to dedicate additional time to support patients, addressing issues such as injection techniques, missed doses, and medication storage.

Proper training on Mounjaro’s use and potential interactions is crucial. Pharmacists must carefully monitor patients, ensuring adherence to treatment plans while minimising risks. Although NICE has endorsed Mounjaro for its cost-effectiveness, variations in accessibility based on geography and socioeconomic factors remain concerns. Collaborative efforts between the NHS, pharmacies, and manufacturers will be critical to managing supply and preventing misuse.

Mounjaro represents a significant advancement in diabetes care, but its rollout must be managed carefully to avoid the pitfalls experienced with other GLP-1 drugs. By focusing on patient education, clear communication, and supply management, pharmacists can help deliver its benefits equitably and responsibly.

Leveraging digital solutions for better patient care

Digital platforms, such as Charac, are transforming healthcare delivery. These tools enable secure video consultations and facilitate personalised care, particularly when managing drugs with significant clinical implications.

Additionally, digital solutions can streamline recordkeeping, replacing manual processes or establishing clinical documentation where none previously existed. Centralised, accessible records allow pharmacists and other healthcare professionals to schedule follow-up consultations, ensure continuity of care, and make informed decisions. By adopting platforms like Charac, pharmacists can improve patient safety and enhance the overall quality of care.

Embracing modernisation in pharmacy

To meet the demands of modern healthcare, the pharmacy profession must adapt swiftly. Integrating technology to strengthen clinical documentation, foster peer oversight, and enhance accountability will enable pharmacists to uphold the principles of healthcare ethics. Through these measures, pharmacists can prioritise patient welfare, maintain professional standards, and ensure safe and effective practices in prescribing weight-loss medications and other treatments.