Prescribing in addiction Flashcards
define controlled drugs
dangerous or otherwise harmful drugs, categorised into 3 distinct classes, A, B and C
what is the misuse of drugs Regulations 2001
stipulates how CDs may be prescribed handled, stored and supplied by pharmacists
name the classifications of controlled drugs
- Schedule 1 (CD Lic POM)
- schedule 2- CD POM
- schedule 3- CD no reg POM
- Schedule 4- CD Benz POM, and CD Anab POM
- schedule 5- CD Inv POM or CD Inv P
Describe the properties of schedule 1 drugs
- virtually no therapeutic use
- social problems through misuse
- a licence is required from home secretary to produce, possess or supply
eg. LSD, ecstasy, cannabis
describe the properties of schedule 2 drugs
- strict control
2 drugs are of great therapeutic value - all are subject to full prescription control, safe custody, witnessed destruction and record keeping
- eg. opiates, major stimulants (amphetamines), ketamine products for medicinal use
describe the properties of schedule 3 drugs
- reduced control- no record keeping, but invoices must be retained
- witnessed destruction is not a legal requirement but good practice
- most require prescription requirements and safe custody (except tramadol, pregabalin, gabapentin)
- eg. temazepam, pregabalin, gabapentin
describe the properties of schedule 4 drugs
- few restrictions
- no safe custody, witnessed destruction or prescription requirements but validity of prescription is 28 days
- good practice to prescribe 30 days clinical need (sch 2,3,4)
- eg. most benzodiazepines, anabolic and androgenic steroids, plus growth hormones, sativex
describe the properties of schedule 5 drugs
- only requirement is that invoices must be retained for 2 years
- dilute preparations of schedule 2 drugs
- prescription validity is 6 months
- some available oTC
- codeine, low strength morphine
give examples of drugs used in substitute prescribing
methadone, buprenorphine
what must a pharmacist check before dispensing a schedule 2 and 3 controlled drug
- the prescription complies with the requirements
- the pharmacist must know the prescribers signature and have no reason to suspect a forgery or
- the pharmacist has taken reasonably sufficient steps to satisfy themselves that it is genuine - within 28 days of appropriate date- including any owings
- marked at the time of supply, with the date on which the drug was supplied
- not over 30 days supply (recommended)
- the prescriber address is in the UK
when can a pharmacist still supply a prescription with technical errors
can still supply if:
- the drug is spelt wrongly
- either words or figures of the total quantity is missing
as long as:
- prescription is genuine and supply is made according to prescribers intention
- amendments are made in ink and pharmacist dates and signs prescription
describe the process of collection of dispensed schedule 2 drugs
- need to establish if it is the patient, patient representative or a healthcare professional collecting
- proof of identity is not always required
- if proof is not established, the pharmacist decides whether to supply CD
- where the person collecting is a healthcare professional, the pharmacist must also obtain their name and address
- good practice for person collecting to sign the back of the prescription
what are the requirements of the controlled drug register
- must be chronological
- be made on day of transaction or the next day
- not to be cancelled, obliterated or altered, but corrected by dated marginal notes
- corrections must be in ink, signed and named
- can be electronic
- must have a running balance
what are the benefits of instalment prescribing
- allows daily supply of substitute
- lives are already chaotic
- avoids temptation to overdose on the first day
- supervised consumption
- greater levels of control
what are the requirements of dispensing MDA prescriptions
- valid 28 days from date
- sign and ID on first visit/representative could collect with prior agreement and letter for each collection
- dispensing fee for each collection
