Controlled Drug Flashcards
What legislation are CDS covered by
Human medicines regulation 2012
The misuse of drugs act 1971
What does the misuse of drugs act cover?
Primary purpose is to prevent the misuse of CDs
It is concerned with unlawful use of certain drugs, and penalties
It does this by imposing a total prohibition on the possession, supply, manufacture, import or export of CDs except as allowed by regulation or by licence from the Secretary of State
How do we classify CDs
Misuse of drugs regulation have 5 schedules
Schedule 1 is subject to the strictest controls and schedule 5 is subject to the least strict
What are schedule 1 drugs and state some examples
These are drugs which have virtually no therapeutic use
Such drugs may only be produced, possessed or supplied for research or other special purposes
A licence from the home office is needed for any of these purposes
Pharmacist need a license to possess and supply
Examples:LSD, ecstasy, methampetamine
What are schedule 2 CDs and state some examples
Used in medicine
May only be supplied to a patient in a prescription which is subject to stringent requirements
Must be kept under safe custody
Registers if transactions must be kept: CD reg
Examples:cocaine, diamorphine, methadone, amphetamine
What are the prescription requirements for schedule 2 CDs
Patient N&A Product name Strength Form- even if one form Dose Total quantity in words and figures Signed and Dated
NO EEA prescribers
Must have for dental treatment only if dentist
Additional CD prescription requirements
If there is only 1 strength available then the strength is not needed but is good practise
Dose instruction as direct is not acceptable but one as direct is (NO PRN OR MDU)
Prescriptions are only valid for 28 days (CD5 is 6months)
Private prescription must be written in a special form FP10CD
What are schedule 3 CDs and state some examples
Not thought to be so liable to misuse as S2 CDs
Almost the same controls as S2 BUT: not all drugs are under safe custody (only temazapam, buprenorphine, diethylproprion, flunitrazepam)
REGISTERS DONT NEED TK BE MADE
examples: midazolam, tramadol
What are the 2 parts of S4
CD benz(odiazapines) CD anab(olic steroids)
Treated more like POM (except only valid for 28 days)
No safe custody
No CD prescription requirements
Examples: zopiclone, diazepam, zaleplon
S5 drugs
Some S2 drugs at different form or concentration
Some are P and POM
This is the only one in which anyone can be in possession
What is a 30 day clinical need
This is a strong recommendation from the DoH but not a legal requirement
The quantity of schedule 2,3,4 CDs prescribed shouldn’t exceed 30 day supply
Prescribers will need to be able to justify on the basis of clinical need, a supply of more than 30 days
How can we as pharmacists change a CD prescription
1) minor typos or spelling mistakes
2) where the total quantity is specified in either words or figures
(Can’t add both)
Pharmacist must sign, date and add there reg number on prescription
What is safe custody
This is locking away in a safe certain drugs
All of S2 and 4 S3 drugs
These require continual supervision
Only the pharmacist can access this
When CD is out of the safe it must be under direct supervision of the pharmacist
CD register
Seperate register for each preparation
Receipts and supplies on one page
Running balances- they must balance
Must make entry on the date of supple or within 24 hours, the next day
Entries must be in ink or indelible
Keep reg for 2 Years form date of the last entry
NEVER CROSS OUT IN CD REGISTER
classification of CDs
Misuse of drugs regulations for schedules
Schedule one being strictest and schedule five being the least strict
What can pharmacist arrange for drug misusers
Supply of drugs
Paraphernalia
What drugs can be supplied via arrangement
Methadone- oral solution
Buprenorphine- subutex not temgesic
Diamorphine
What does the misuse of drugs regulation state about prescribing for drug addicts
It states that doctors are prohibited from prescribing, administering or supplying the following drugs for the treatment of addiction
Diamorphine, cocaine, dipipanone
Except under a Home office licence
No other types of prescribers can off these drugs for the treatment of addiction
What 2 forms can CDs come on for treatment of addiction
FP10CD
FP10MDA- blue form A
FP10MDA
Blue form
Issued by drug treatment centres or by GPs
Max of 14 day supply-NHS rules
Instalments permitted often daily- patient comes into pharmacy daily
What modes of therapy are there for addiction
Detoxification-stopping few people go through this
Maintenance
What is supervised self administration
This is when we have to check they are taking it, usually for 1st 3 months- usually oral not inject
1) place in consolation room
2) watch them take it
3) give them water
4) check there mouth
5) never let them bring own drink
Who can give out paraphernalia and what can they give
Doc Dentist Pharmacist Nurse People engaged in the provision of drug treatment
Needles, swabs, citric acid, spoon, WFI (POM but can get via PGD), aluminium foil
Emergency supply with CDs
Not permitted for any S2 or S3 CDs
Except: phenobaribtone in treatment of epilepsy
For phenobarbitone, S4 and S5 CDs we can only give 5 days supply NOT 30
What is a requisition
When a practitioner requires a CD for some other purpose (keep in stock or research)
CD requisitions must be of a FP10CDF form this is a legal requirement
Why would someone require a CD
FP10CDF
Doctor- supply in practise
Scientist- research
Nurse in charge of ward- emergency or use in practise
Manager if an offshore installation or master of a ship- far away form medical help therefore will need to keep it on the ship
When will we need to destroy CDs
Patient return- no longer needs or out of date
Doc return- no longer needs or out of date
Our own stock- out of date
We have to destroy o
What are the rules for waste management treatment in England
Individuals (including pharmacist) require an environment permit in order to lawfully manage or treat waste medicine
There are some exemptions from this requirement
An exemption is not a permit
What is the non waste frame work directive (NWFD)
Permits pharmacists to receive waste medicines from households and individuals, not treat waste
Pharmacist are automatically granted this exemption so don’t need to apply for
We are obliged to accept unwanted medicines
What waste management can we do
Remove confidential information- dispensing labels
Remove blister from box to be recycled
We’re are allowed to decanter and deblister CDs and denature them in pharmacy-T28 exemption
Destruction of our own cd stock
This is already in register
Part of own stock so need you I account for will he destruction
Need an authorised witness for destruction
Enter in the CD register
Who is the authorised witness
People authorised by am accountable officer (they oversee CDs in the area)
AO may not witness the destruction
Enter in CD register, sign by authorised person
Authorised person may take sample of the drug
