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Psychiatric Bulletin (2002) 26: 394. doi: 10.1192/pb.26.10.394-a
© 2002 The Royal College of Psychiatrists
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Psychiatric Bulletin (2002) 26: 394
© 2002 The Royal College of Psychiatrists

Correspondence

Off-label prescribing

Francesca Lowe-Ponsford, Locum Consultant Psychiatrist

Box 317, Adrian House, Fulbourn Hospital, Cambridge CB1 5EF

David Baldwin, Senior Lecturer in Psychiatry

University Department of Mental Health, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG

Sir: We enjoyed reading the article by Lawrence et al (Psychiatric Bulletin, June 2002, 26, 230-232). The findings complement some work that we have done in this area (Lowe-Ponsford, Psychiatric Bulletin, 2000, 24, 415-417). Our postal questionnaire found that 65% of psychiatrists who replied had prescribed ‘off-label’ within the preceding month.

Medico-legal advice that we obtained (from the Medical Protection Society) was that, not only does Bolam (1957) need to be taken into account, but also the case of Bolitho (1997). This judgement means that the treatment has to withstand logical analysis as well as be accepted by a body of opinion. These considerations need to be taken into account in prescribing, alongside the capacity of the patient.

Many psychiatrists are worried about off-label prescribing and our study showed that 4% of respondents had received complaints about this matter. In our paper, we suggested some guidelines that may avoid many future medico-legal problems for clinicians if they should prescribe off-label.

The College's Psychopharmacology Special Interest Group has discussed this matter and is setting up a small working group (chaired by D. B.) to review the practice of off-label prescribing. We would be delighted to receive the thoughts of colleagues on this subject.

References

Bolam v. Friern. Hospital Management Committee [1957] 2AIIER 118, 1 W:R 582.

Bolitho v. City and Hackney Health Authority [1997] 3 WLR 1151.





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