IT is difficult to get sleeping pills in large quantities from general practitioners (GPs) here, going by a recent test carried out by The Straits Times.
Two journalists, posing as patients, visited 30 clinics, including two in Johor Baru, and found that they could not get more than two to four weeks' worth of pills at most clinics.
These were mostly benzodiazepines, the most commonly used class of sleeping aids here. None of the clinics visited prescribed Dormicum, which is known to be highly addictive.
Under the latest guidelines issued by the Ministry of Health (MOH) on benzo-diazepines, doctors have been advised against dishing out pills like Dormicum and Erimin because of their highly addictive nature.
The only time the journalists' ruse yielded Dormicum was in a JB clinic. The doctor there prescribed 30 tablets with minimal questions asked, raising a flag on a potential loophole in regulations here.
At each clinic visited, the two journalists said they had difficulty falling asleep, woke up in the middle of the night and were stressed from work.
Three GPs turned them away, saying they did not stock sleeping pills. One refused to give sleeping pills and doled out advice on good sleep habits instead.
Five GPs provided sedative antihistamines, normally prescribed for flu or allergies and cause drowsiness.
The others prescribed a variety of sleeping pills - Stilnox, Diazepam, Innovane and Ativan - all of which are commonly prescribed here and fall within medical guidelines.
Adjunct Associate Professor Munidasa Winslow of the department of psychological medicine at the National University Health System, when showed the sleeping pills obtained, said the low quantity each doctor gave showed the guidelines were being closely followed.
Principal clinical pharmacist Ng Boon Tat from the Institute of Mental Health, on examining the sleeping pills obtained, said most were within the guidelines. He expressed concern about the 30 tablets of Dormicum from the JB clinic, because of its quantity and potential for abuse.
He stressed that medications to help people sleep and relax should typically be taken in concert with lifestyle changes, like cutting caffeine intake and not doing strenous exercises just before bedtime.
More than 20 doctors here have been disciplined for prescribing sleeping pills inappropriately in the last five years. Those who do so can make quick profits by buying the pills cheaply and selling them at a higher price.
The guidelines on how benzodia- zepines should be prescribed, issued by MOH last October, require doctors to indicate in the patient's record the dosage, duration of use and reasons for prescribing the pills. They also must look out for signs of illicit use and alert the ministry and the Central Narcotics Bureau if they suspect a patient is abusing sleeping pills.
Dr Lim Li Ling, the medical director and consultant neurologist at the Singapore Neurology and Sleep Centre, said the treatment of insomnia should be based on the root cause.
'Doctors should interview patients to determine if, for example, it is stress, anxiety or 'restless legs syndrome' and target the specific cause,' said Dr Lim, who also heads the Singapore Sleep Society.
This article was first published in The Straits Times on Jan 2, 2009.
