4. Controlled Drugs

Question 1

What is a controlled substance

Answer 1

a substance included in schedule 1,2, 3, 4, or 5

Question 2

What is a practitioner

Answer 2

A person who is registered and entitled under the laws of a
province to practice in that province the profession of medicine,
dentistry or veterinary medicine, and includes any other person or class
of persons prescribed as a practitioner

Question 4

What does it mean to provide?

Answer 4

To give, transfer or otherwise make available in any manner,
whether directly or indirectly and whether or not for consideration

Question 5

What does it mean to sell?

Answer 5

to legally offer for sale, expose for sale, have in possession for sale and distribution

Question 6

What does it mean to traffic?

Answer 6

to sell based on other than under the authority of the regulations
illicit sale

Question 7

What is the purpose of the controlled drugs and substances act?

Answer 7

1. to fullfil CAD’s obligations under international conventions
2. to estab domestic controls over distribution/possession of some psychotropic substances not listed in schedules to one of the inter. conventions
3. to rectify deficiencies in prev. drug legislation
4. to consolidate narcotics act and parts3 + 4 of food and drugs act into 1 piece of legislation
5. to control the availability and possession of psychotropic substances in canada

Question 8

What is a psychotropic substance?

Answer 8

has the capacity to prod a state of dependence and CNS stimulation/depression
dependence includes both psychological and physical dependence

Question 9

Give an overview of what activities are illegal unless authorized in the regulations?

Answer 9

possession other than named practitioners or person with a prescription for a person or animal
double doctoring
trafficking, possession for the purpose of trafficking
importation, exportation and possession for the purpose of exportation
production

Question 10

What types of drugs might make it a controlled drug?

Answer 10

identified in the controlled drugs and substances act schedules | -> V||||
Schedule | substances most tightly controlled w/ most severe punishments
most commonly used vet drugs listed under schedule 1 and 4
exemption for certain anabolic steroid derivatives when contained in an agricultural implant

Question 11

What controlled drugs might be on shedule 1?

Answer 11

metamphetamines - ephedrine, phenylpropranolamine, pseudophedrine
Opiods - morphine, dihydrocodeine, hydrocodone, hydromorphone, apomorphine, naloxone, oxycodone
Coca (cocaine)
phenylpiperidines, methadols, morphinines, fentanyls

Question 12

What are some schedule 4 controlled drugs?

Answer 12

Barbiturates (phenobarbital,
pentobarbital), thiobarbiturates,
butorphanol, benzodiazepines (alprazolam,
clonazepam, diazepam, midazolam), anabolic
steroids

Question 13

What are some examples of narcotics?

Answer 13

Heroin (diacetylmorphine)
* Cocaine
* Methadone
* PCP (phencyclidine) - ketamine
* Morphine (and derivatives e.g. hydromorphone, fentanyl)
* Codeine

Question 14

What is the least controlled drugs listed in the CDSA schedules?

Answer 14

benzodiazepines and other targeted substances

Question 15

Why are benzodiazepines and other targeted substances under the controlled drugs?

Answer 15

possession, sale and distribution covered as schedule 4 and CDSA
ID on label w/ T/C in square
control sale and distribution of benzodiazepines and other targeted psychotropic substances
EX. diazepam - sedative, anticonvulsant
alprazolam, clonazepam - antianxiety, behavioural mod

Question 16

What are some controlled drug regulations?

Answer 16

possession, Pr requirements, repeats, ordering, record or receipt and dispensing, storage, disposal

Question 17

What are provincial requirements?

Answer 17

written (provincial) can be faxed or e-written, sask pharmacists can request written only as written Pr’s is a provincial req
verbal* (federally) federal law allows verbal Pr (must be recorded by a pharmacist), vets technically follow federal law, but licensed pharmacy can require in writing
verbal orders are allowed for in-hospital use, must be recorded into permanent record
duty to ensure Pr is legitamate

Question 18

Controlled Pr’s are generally similar to Pr drugs. What are some exceptions?

Answer 18

prescribing methadone req special exemption
provincial pharmacy standards do req that in case of repeats, the interval btw repeats is also stately clearly (ex. 3 repeats every 30 days), no repeats allowed for narcotics

Question 19

What are some reasonable attempts to limit access to an unnecessary controlled drug? Intent of the law

Answer 19

limiting quantity of schedule 1 drugs dispensed at a time to 1 mo
limiting quantity of schedule 4 drugs used for maintenance of chronic conditions to 3 mo
(phenobarbital for epilepsy)

Question 20

What are some best practices about record keeping controlled drug logs?

Answer 20

1 person assigned to oversee logs - weekly reconciliation is recommended
Daily, weekly, monthly depending on size of practice
Logs to be kept separate from actual drug to minimize ability to alter logs/remove completely
ambulatory (any) practice cannot keep logs w/ drug bottles
when reconciling, hub of needle holds 0.05mls of solution
errors are crossed out with a single stroke>correction made>initialed
must be in blue/black pen

Question 21

what are 3 reasons to discard a controlled drug?

Answer 21

spills and breakage - recorded as such, in dispensing log, dated, signed by DVM and witness
Expired drug - must be disposed of in presence of witness (legally another practitioner, but RVT or other staff person is acceptable when there is no other practitioner available) and recorded in dispensing log. referred to as discard
1 discarding unused, assigned amounts that were originally prescribed for a patient. must be recorded and witnessed (see section on records). referred to a wastage. giving drug to effect and the entire drug not used

Question 22

How IS a controlled drug discarded?

Answer 22

either destroy in-hospital or return to licensed dealer
no regulations related to method of destruction or discarding of controlled substances
drug must be altered or denatured to such an extend that its composition has rendered impossible/improbable - SVMA recommends squirting volumes into cat litter before discarding into biohazard waste container
All waste and discard must be recorded and witnessed by a health care professional

Question 23

What is important about loss and theft of a controlled drug?

Answer 23

theft is easier to detect, loss is difficult to detect
must be reported within 10d of discovery of the theft
report to the office of controlled substances, health Canada
listof missing drugs, amounts, the date of (discovery of) loss
also requires a post-loss review and risk mitigation plan to prevent future loss/theft

Question 24

What is an example of diversion?

Answer 24

using for purpose other than intended.

• entering a quantity of drugs into inventory that is different from quantity received
• pilfering and reporting a missing dose
• replacing package contents with look-alike drug
• replacing prepared syringe contents with saline
• removing controlled drugs without an order
• falsifying a verbal or electronic order
• documenting administration of drugs without doing so
• removing and documenting administration of a full dose, but administering a partial dose
• removing a higher dose than ordered and not wasting the excess
• pilfering from drug waste, sharps containers, or patches removed from patients
• pilfering patient-supplied drugs or not returning them at discharge
• removing drugs for a discharged or nonexistent/ deceased patient

Question 25

What are signs of diversion?

Answer 25

missing purchase order or packing slip
* compromised packaging (watch for excessive “accidents” and check rubber stoppers for
punctures)
* verbal orders created but not verified by prescriber
* numerous unresolved discrepancies
* numerous corrected transactions
* removing drugs for more patients than are generally assigned to a single practitioner
* failing to document waste
* failing to discard wastage or render it unusable
* frequent breakage or waste of entire doses
* controlled drugs disposed of in regular trash; staff member frequently volunteering to take
out the trash
* patient or family complaints of inadequate pain management