controlled drug Flashcards
what is controlled drug
- A drug that causes harm when misused
- Often have potential for abuse as a recreational drug
or for other purposes e.g. anabolic steroids in bodybuilding
misuse drug act 1971
Drugs subject to the control of the Misuse of Drugs Act and listed within it are
termed “Controlled Drugs”
* Divided into Classes A, B and C depending on the harmfulness when misused,
which determine the maximum penalty that can be imposed
The health act 2006
- Introduced the concept of an Accountable Officer – role is to have overarching
responsibility for supervising and managing the use of CDs in their organisation - Overseeing the monitoring and auditing of the management, prescribing and use of CDs
- Ensuring systems for recording concerns and incidents involving CDs are in place
- Attendance at local intelligence network meetings
- Occurrence reports
- Appointment of authorised witnesses for the destruction of CDs
- Requires healthcare organisations to have SOPs in place for using and managing CDs
- Gives power to police and other nominated people to enter premises and inspect stocks
and records of CDs
misuse of drugs (safe custody) regulations 1973
*Imposes controls on the storage of CDs:
Must:
* Be lockable (by key)
* Be made of metal
* Be fixed to wall or floor
* Have nominated key holder who
has responsibility for safe custody
of keys
misuse of drugs and misuse of drugs (safe custody) amendments regulation 2007
*Accountable officers: nominate persons or groups
to witness the destruction of CDs
*Removed the requirement to maintain a Controlled
Drug Register in a prescribed format
*Changed the record keeping requirements for CDs
*Rescheduled midazolam from Schedule 4 to
Schedule 3
misuse of drug regulation 2001
*Defines the type of person authorised to manufacture, import,
export, possess, prescribe and supply CDs in their
professional capacity for medical or other use.
*Divides CDs into 5 schedules. Depends upon its therapeutic
benefit against its harm when misused:
*Schedule 1 CDs - highest level of control
*Schedule 5 CDs – lowest level of control
schedule 1 (CD lic POM) examples
- E.g. LSD, ecstasy, mescaline, cannabis
- The majority of drugs in Schedule 1 have no recognised therapeutic use
- Generally limited to research – must hold a home office licence
- Practitioners may not lawfully possess these except under licence from
the Home Office
Pharmacists cannot take possession of the material
except:
*For the purposes of destruction
*For the purpose of handing over to the police
*Under no circumstances return Schedule 1 drugs to a
patient at discharge
schedule 2 (CD POM)
Includes
* Diamorphine
* Morphine
* Methadone
* Oxycodone
* Major stimulants (amfetamines)
* Quinalbarbitone
* Ketamine
* Supply is restricted to licensed wholesalers, hospitals and pharmacies,
doctors and dentists acting in their professional capacity
* A licence is required to import or export
- CD prescription requirements apply
- Safe custody (except quinalbarbitone) apply
- CD register for supplied (dispensing) and obtained (deliveries)
- Destruction – by appropriately authorised person with authorised witness and keep record
- Prescription valid for 28 days
- Emergency supplied NOT allowed
- Repeat prescribing NOT allowed
schedule 3 (CD no register POM)
Includes: buprenorphine, midazolam, phenobarbitone, temazepam, tramadol
* Subject to CD prescription writing requirements
* Most are exempt from safe custody requirements (except temazepam and
buprenorphine)
* No CD register record is needed
* Emergency supply is not allowed (except for phenobarbital for epilepsy)
* Repeat prescribing is not permitted
* Script is valid for 28 days
* Invoices must be retained for 2 years
* Subject to full import and export control
* The requirements relating to destruction do not apply
* New to this category (April 2019) is pregabalin and gabapentin
schedule 4
Prescription writing as per POM requirements
* Exempt from safe custody and CD entry recording
* Script is valid for 28 days
* Subjected to full import and export control
* EEA (European Economic Area) and Swiss prescribers can legally prescribe
* Repeat prescriptions are allowed
* Emergency supplies are allowed (max of 5 days should be given)
* This schedule is split into:
* Part I (CD Benz POM), which contains most of the benzodiazepines (e.g. diazepam),
non-benzodiazepines (e.g. zolpidem, zopiclone) and Sativex® (a cannabinoid oral spray)
* Part II (CD Anab POM), which contains anabolic and androgenic steroids (e.g.
testosterone), clenbuterol and growth hormones
schedule 5
Contains certain Schedule 2 CDs in low strengths (e.g. codeine, pholcodine
and morphine) which are exempt from full control
* Invoices must be kept for two years
* A practitioner, pharmacist or a person holding an appropriate licence may
manufacture or compound any schedule 5 substances
* Some are available OTC
Quantity supplied for CD? Good practice and legal requirements
The quantity prescribed should be appropriate for the
clinical need of the patient
* Schedule 2, 3 and 4 should be limited to 30 days supply
* This is good practice and not a legal requirement
– use your professional judgement, but prescribers should
justify why more than 30 days is needed in all cases
owings of CDs
Owings = when you can’t supply full amount at once, the remaining amount
is called an ‘owing’ e.g. prescription for 56 tablets, only 28 in stock. Dispense 28 and
you owe the patient 28. Supply the ‘owing’ 28 when order is received. Patient comes back
another time to collect them.
* Owings- CD register must only record what is actually supplied. A further
entry must be made when the remaining balance is supplied e.g. on Monday,
supply 28, make register entry for 28; receive order on Tuesday, dispense owing 28, make
another register entry for 28.
* The owing balance for schedule 2, 3 or 4 CDs cannot be dispensed later
than 28 days after the date of the prescription
* For Schedule 5 CDs, the balance of an owing cannot be collected more than
6 months after the date of the prescription
collection of dispensed CD
*Pharmacist is legally required to determine who is collecting
Schedule 2 CD
*Ask for proof of identity (unless already known to the pharmacist)
*Pharmacist has the discretion to decide to supply even if ID is not
provided
* Depending on who is collecting, pharmacists need to take different action
* When ………….collects dispensed CDs
* Patient Request ID
* Patient’s representative Request ID
* Healthcare professional
CD destruction
- Pharmacy contractors must have appropriate arrangements in place for the safe
disposal of CDs - The home office advises that all schedule 2, 3 and 4 (part 1) CDs should be
denatured (irretrievable) before being placed into waste containers - Pharmacists should use CD denaturing kits to denature CDs wherever possible,
or another suitable product e.g. cat litter!
