CDs - destruction Flashcards
Why is denaturig CDs important?
- Prevents the drug being retrieved and misused
- Prevents harm to the environment
- Ensure the waste may be transported safely with less risk
exemption for pharmacies to be able to denaturing CDs before disposal without a licence
‘T28 exemption’
- exemption is issued by the Environment Agency (England and Wales)
- providing the pharmacy has registered their exemption with the Environment Agency
What CDs should be denatured before disposal?
all CDs in schedules 2, 3 and 4 (part 1)
2 different CD destruction scenarios
- out of date stock
- CDs returned by a patient or their representative
storage of out of date stock of CDs before destruction
if requires safe custody must be kept segregated from other CDs in the CD cabinet
destruction of Sch 2 stock that is out of date
must be witnessed by an ‘authorised person’
What is an ‘authorised person’
a person authorised by the Secretary of State or authorised by a CD Accountable Officer
Can an Accountable Officer be an ‘authorised person’?
NO
What does the authorised person do when destruction of CDs?
record the destroyed quantities in the CD register
and
sign the register entry
authorised person and destruction of other schedules apart from Sch 2
NO LEGAL REQUIREMENT for authorised person to be present for destruction of other schedules
records for destruction of other schedules apart from Sch 2
NO LEGAL REQUIREMENT for records to be kept of destruction of other schedules
destruction of schedule 3 CDs
good practice to have another member of staff (preferably a registered healthcare professional) witness the denaturing
When should destruction of CDs that are patient returns take place?
should be destroyed as soon as possible and not allowed to accumulate
storage of patient return CDs before destruction
should be segregated, stored appropriately (CD cabinet if legally required) and clearly marked for destruction
CD register and Sch 2 CDs that are patient returns for destruction
- NOT entered in the CD register
- good practice to keep record of Sch 2 CDs returned by pts (but NOT in the CD register)
how long to keep record of patient retuened CDs
7 years
witness and patient returned CDs
good practice for another member of staff (preferably a registered hc professional) to witness destruction
waste from care homes CDs returned by
a hc professional
pharmacies can’t accept any waste medicines (incl CDs) from care homes that provide nursing care or CDs returned by a hc professional
destruction of Schedule 2 CD - info in record
- Date received
- Received by (name and signature)
- Patients name (if known)
- Patients address (if known)
- Name of CD
- Form & strength of CD
- Quantity of CD
- Role of person returning the CD (if known)
- Date destroyed
- By pharmacist (name and signature)
- Witnessed by (name and signature)
- 1st 8 when received
- last 3 when the CD is destroyed
How are CDs destroyed?
- waste should not into the sewage system (toilet/sink)
- Sch 2, 3, 4 (part I) must be denatured before disposal
- CD denaturing kits preferred
- health & safety measures are taken when denaturing (PPE, ventilated area)
- denaturing kits with denatured CDs put in general pharmaceutical waste bin
denaturing CDs - solid dose formulations
- grind or crush the tabs/caps, pestle and mortar
- add to the CD denaturing kit
- small amount of water during grinding may min risk of particles releasing into air
- ground/crushed powder into CD denaturing kit, + water to ‘fill’ line
- put on lid & shake vigorously
- no denaturing kit: grind/crush tabs/caps, into warm, soapy water, stir to dissolve/disperse, add mixture to an appropriate product (cat litter?)
- into general pharmaceutical waste bin
denaturing CDs - liquid dose formulations
- CD liquid poured into the CD denaturing kit
- don’t add liquid above the ‘fill’ line
- add water to the ‘fill’ line
- lid on and shake vigorously
- no denaturing kit: use appropriate product (cat litter?), add to the general pharmaceutical waste bin
- empty CD bottleined rinsed, rinsings poured into the kit
- empty bottle can disposed in general waste/recycled
- labels with patientidentifiable details removed OR details obliterated
denaturing CDs - parenteral formulations
ampoules with liquid:
- opened and emptied into the CD denaturing kit
- process as for liquids
- ampoule disposed of in a sharps bin
ampoules with powder CD:
- opened, water added to dissolve the powder
- mixture into the CD denaturing kit
- process as for liquids
- ampoule disposed in sharps bin
- less preferred method: crushing the whole ampoule and its contents
denaturing CDs - patches
- remove backing on patch
- fold the patch over on itself (sticky side inwards)
- into CD denaturing kit
- MEP: folded patch can be disposed of in a waste bin (?)
denaturing CDs - aerosols
- expelled into water to prevent droplets of drug entering air
- solution can then be disposed of like destruction of liquid formulations
- if not possible, expel the contents onto an absorbent material and add to the general pharmaceutical waste
Disposing of methadone bottles
- rinsed
- liquid added to CD denaturing kit
- kit added to the pharmaceutical waste when full
- liquid waste meds not poured down sink/toilet
- don’t have to record disposal of rinsings
- dispensing labels removed or obliterated
- clean, empty container disposed in normal waste bin
Sch 2 CDs that can be on PGDs
- morphine
- diamorphine
(both only by registered nurses/pharmacists for immediate necessary Tx of a sick/injured pt, EXCEPT for treating addiction) - ketamine
Sch 3 CDs that can be on PGDs
midazolam
Sch 4 CDs that can be on PGDs
ALL drugs
** except anabolic steroids and injections used for treating addiction
Sch 5 CDs that can be on PGDs
ALL drugs
Who cannot administer/supply any CD (in any schedule) on a PGD?
- Dietitians
- Speech and language therapists
- Dental therapists and dental hygienists
2 groups of drugs that it is an offence to drive with certain levels in the body
- commonly abused drugs (cannabis, ecstasy, ketamine), LOW LIMIT SET
- licensed medicines that can be abused
licenced meds that can be abused that have limits for driving
- flunitrazepam
- clonazepam
- oxazepam
- diazepam
- lorazepam
- temazepam
- methadone
- morphine
usual limit for licenced meds and driving
higher limit set
usually above the normal therapeutic range
What can patients use if they taking commonly licenced abused meds and driving?
statutory medical defence if:
- drug lawfully prescribed, supplied or purchased OTC
- drug taken in accordance with advice by prescriber/supplier and in accordance with any written instruction
if driving impaired with licenced abused drugs
section 4 of the Road Traffic Act 1988 will still apply if driving impaired
no statutory medical defence for this
counselling for drugs and driving
- warning label packaging & PIL regarding driving
- counselling important
- warn about driving, esp if med newly prescribed or dose increased
- advise to carry evidence that they are prescribed the drug (repeat Rx, labelled bottle)
- avoid alcohol
- alert for new drugs started that can interact with listed substance and inc its serum levels
Extemporaneous preparation of methadone liquid
- Schedule 2 CD
- extemporaneous methadone = unlicensed medicine
- licensed preparation should always be used in preference to an unlicensed version
- methadone powder ordered from wholesaler needs to be entered into CD register when delivered, then weight used to prepare liquid needs to be enterd out
- liquid prepared in this way needs to be entered into CD register after prepared
- pt & prescriber informed that it’s unlicensed
What items can be supplied to aid drug abuse?
- swabs
- utensils for preparation of a CD
- citric acid or ascorbic acid
- filters
- WFI
Who can supply items to aid drug abuse?
- practitioner
- pharmacist
- employee/providine drug Tx services
- SP acting under CMP
- nurse IP
licence from Home Office to travel with CDs
NOT required if travelling with less than 3 month’s supply of a CD
recommendations for travelling with CDs
recommended to bring covering lettersigned by prescriber confirming the pt’s name, drug name, dose, quantity and travel plans
address on CD Rx
- address is a legal requirement
- but home address not specified
alternative address on CD Rx
- alternative address can be used in cases such as witness protection
- ‘NFA’ can be used if homeless, NOT a valid address but can be used
- can use address of GP surgery
Psychoactive Substances Act 2016
- bans production, distribution, sale and supply of psychoactive substances
- previously known as ‘legal highs’
What are psychoactive substances?
any substance capable of producing a psychoactive effect in a person who consumes it, and is not an exempted substance
exempt substances from Psychoactive Substances Act 2016
exampt substances:
- controlled drugs
- medicinal products
- alcohol or alcoholic products
- nicotine
- tobacco products
- caffeine
When is it an offence to have psychoactive substances?
- possession NOT an offence except in a ‘custodial institution’
- possession with intent to supply, import or export is an offence
What does Emergency measures relating to CDs during a pandemic mean?
- 3 temporary emergency measures
- introduced but NOT ACTIVATED
- announcement from the Secretary of State to say which measures activated, how long they’ll apply (start date), geographical area where they apply
- onyl apply if severe disruptions to supply of repeat Rx for CDs
- measures will only last forduration of emergency
- max 3 months (could be extended for another 3 months)
3 emergency measures relating to CDs during a pandemic
1) Emergency supply of CD at request of patient - allows supply of sch 2 or 3
2) Supply of a CD under a SSP - extends use of SSP to include Sch 2, 3, 4 (Part 1) CD, only used as last resort, exceptional
circumstances, SSP will be highly specific
3) Enabling pharmacists to vary the frequency of dispensing an
instalment prescription (FP10MDA) - only if consulted prescriber (or prescriber rep)
