Pharmac's decision to widen prescribing rights for a medicine used to treat severe acne has drawn concern from health experts and local educators.
Isotretinoin (better known as Roaccutane or Isotane) is a vitamin A derivative which has been available for more than two decades to treat severe nodulocystic acne not responding to conventional treatment.
The drug can have serious side effects, including depression, psychosis, suicidal thoughts or actions, aggressive and violent behaviours, and an increased risk of birth defects if taken during or before pregnancy (teratogenicity).
For these reasons, the drug has only previously been subsidised when prescribed by a specialist dermatologist.
Pharmac's decision means general practitioners and nurse practitioners will be able to prescribe these medicines on a subsidised basis from March next year, provided they have training and receive special authority from Pharmac.
The New Zealand Dermatological Society and The Australasian College of Dermatologists are critical of Pharmac's decision and are worried the stringent safety measures will not be upheld if the "potentially dangerous" drug is more easily prescribed.
New Zealand Dermatological Society president Dr Liz Baird said due to the severity of the potential side effects, local dermatologists have been conservative in the prescription of the medication.
"We know the potential damage that could be caused during a pregnancy would be devastating, so we have been extremely vigilant in ensuring our clients are fully informed of the importance of avoiding pregnancy while on these medications."
Dr Baird said severe acne was a difficult condition to treat and its therapy required significant training, particularly with regard to the use of isotretinoin.
It was a medication with many dermatological side effects which often needed to be separately managed during the course of treatment.
The medicine is still strictly "specialist only" in Australia and the United Kingdom.
The United States recently tightened control of isotretinoin prescriptions and patients are closely monitored, she said.
Kaikorai Valley College principal Philip Craigie said the school had not experienced any problems with pupils on isotretinoin, but did not rule out the possibility in the future as a result of the Pharmac decision.
"There are people in schools on all sorts of medications for all sorts of things. This is just another one to add to the list."
Otago Girls High School guidance counsellor Ada Crowe said life for young people with serious acne could be difficult and caused low self-esteem in many.
Taking the drug would be a difficult balancing act between the risks and the benefits.
"I think people should be well informed of the potential side effects if they are going to use it," she said.
The New Zealand Dermatological Society and the Australasian College of Dermatologists will be monitoring the training given to general practitioners who wish to prescribe isotretinoin, to make sure it continues to be used safely and appropriately.
