Letter Re: Legalities of Prescribing Long-Term Antibiotics

A reader wrote to ask: “I have talked to a local doctor who is sympathetic about giving prescriptions for antibiotics but he is concerned about the legalities of supplying anyone with excessive amounts of any drug.  Does anyone out there know the proper process to undertake this acquisition?  I’m not worried about buying stuff outright and am willing to use multiple pharmacies but he is worried about getting in trouble and wants to know the legalities.  Any wisdom you or your readers can share? “

Doctor Koelker Replies: Doctors prescribe long-term antibiotics for many different problems, including conditions as simple as acne, to those as complex as HIV disease.  In 20+ years of medicine, I’ve never had a pharmacy question the need for a prescribed long-term antibiotic, other than issues of allergy or cost.  In this era of mail-away prescriptions and pharmacy pricing wars, it is not uncommon for a physician to prescribe 90 days of medication, even an antibiotic.      

It also isn’t that uncommon for a doctor to write an antibiotic with the understanding that a patient will use it under certain conditions.  For example, severely asthmatic patients may be advised to begin an antibiotic every time they get a cold.  A woman with frequent urinary tract infections may keep a sulfa drug on hand for use as soon as symptoms occur.  A missionary traveling to Africa may be prescribed long-term ciprofloxacin for a periodically recurring prostate condition.

I spoke with a lawyer about this, and she doubted that specific laws exist that address this question.  If they do exist, they would likely be state by state.  More likely the issue would be one of opinion, or ethics. Would the state medical board (in charge of licensing) censure a doctor for writing long-term antibiotics?  This lawyer agreed with me that keeping a contract in your medical chart outlining the proposed use and limits of liability would be a good idea.  As a physician, I would not prescribe long-term antibiotics for anyone I could not trust.  The patient would have to agree to my conditions as well as regular follow-up for other medical problems.  Of course, it’s not likely that a prepper patient currently has an infection requiring a long-term antibiotic, though he or she may well have some other problem, such as hypertension or diabetes. 

One thing patients, physicians, and pharmacists must not do is practice deception or give the appearance of deception.  The medical record is a legal document and doctors must record transactions such as prescribing antibiotics, including the reason for doing so.  At least in my home state, doctors cannot prescribe for patients they have not seen personally, and must have a chart on file for every patient seen. Going to different pharmacies or physicians may spare the professionals the issue of questionable prescribing, but this puts the patient at risk of being labeled a doctor-shopper or drug-shopper.  You need to be above-board about everything.  If you want antibiotics for an end-of-the-world scenario, don’t say you need it for acne.  Broken trust is very difficult to repair.  And please don’t ask your doctor to lie for you by saying an antibiotic is for a medical problem that you don’t actually have. 

The lawyer also pointed out the ethics of individual versus government responsibility for crisis preparation, as well as the malpractice question, which would not be a problem if no harm had come.

Of course, a doctor could prescribe an antibiotic for TEOTWAWKI, but what happens if a patient decides to share his supply now with a neighbor suffering from a bad cough, and that neighbor subsequently suffers an allergic reaction and dies?  Who is responsible here?  Although it is currently illegal for a person to “share” antibiotics or other prescription medication, therefore putting the onus on the patient, it is not unreasonable to think the prescribing doctor might get snared as a deep pocket in a lawsuit – all the more reason to keep a contract in the patient chart specifying that the medication will not be used unless civilization collapses.

So again, the issue boils down to one of trust.  Would I trust a prepper patient to uphold the agreement not to use an antibiotic supply unless the current medical establishment collapses?  Like it or not, this is an issue to be settled between your physician and yourself, at least in this country.  Another option would be to travel outside the U.S. to obtain antibiotic supplies, but I have no experience in this arena. (Doctor Koelker is SurvivalBlog’s Medical Editor. She is also the editor of ArmageddonMedicine.net.)