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What is a controlled drug?

One that is controlled under the Misuse of Drugs act (1971)
Controlled drugs in healthcare are medicines subject to both the Medicines act and the MDA (misuse of drugs act).

1

When dispensing CDs, what act requirements apply?

Medicines act requirements apply, PLUS additional requirements of the Misuse of drugs act (MDA)

2

The MDA places additional controls on certain substances that are likely to be misused or abused. What two substances omit this? (ignored?)

Nicotine
& alcohol
Two of the most harmful and commonly used drugs

3

The misuse of drugs act makes total prohibition (totally bans) possession, supply, manufacture, import and export of certain substances, except as allowed in ___________________ regulations, or under ______.

Allowed in the Misuse of drugs act regulations
Or under LISCENCE

4

How many schedules are CDs classified into?
What does this depend on?

5 schedules
Depends on their perceived likelihood to be misused and the potential risks that misuse may present to the individual or society.

5

Tricky question: what are the 5 different CD schedules abbreviations?!

Sch 1: CD Lic POM
Sch 2: CD POM
Sch 3: CD no register POM
Sch 4: Part I (CD Benz POM)
Part II (CD Anab POM)
Sch 5: CD Inv POM or CD Inv P

6

How to find out what schedule a CD is?

Look up RPS (royal pharmaceutical society)
Look up list of medicines for human use
Their classes will be listed

7

What are the Schedule 1 drugs? (CD Lic POMs)

These drugs have no current therapeutic use
Such as LSD, Ecstasy, MDMA, also cannabis
Production, supply and possession of these drugs needs home office Liscense

8

What about patients confidentiality when handing in schedule 1 controlled drugs such as cannabis and LSD?

patient's confidentiality should normally be maintained and the police should be called on the understanding that the source will not be identified. If, however, the quantity is so large that the drug could not be purely for personal use the pharmacist may decide that the greater interests of the public require identification and the identity of the person should be asked.

9

Can you just grab a schedule 1 CD off a patient, as the shouldn't have it on them anyway?

No, The patient should give authority for the drug to be removed and destroyed.
If the patient refuses, the pharmacist may feel that they have no alternative other than to call in the police. ☎

10

Are there any circumstances when you can give a schedule 1 controlled drug (eg LSD, cannabis) back to a patient?

NO
Under no circumstances can a suspected illicit drug be handed back to a patient.

11

When can a pharmacist possess schedule 1 controlled drugs without a home office LISCENCE?

When possession is for destruction
When possession is for handing to police

12

What is the only exception to schedule 1 requirements?
Why?

Sativex
It does have therapeutic use
Pharmacists DO NOT need a Liscence to possess or supply this
Sativex is a cannabinoid medicine for multiple sclerosis

13

What are schedule 2 drugs?

Opiates, major stimulants, quinalbarbitone
Eg of opiate: Methadone

14

Do pharmacists have legal authority to handle schedule 2 CDs? (CD POMS)

They have general authority to possess, supply, and procure (obtain) schedule2 CDs when Acting professionally.
can only supply if a VALID prescription is present.
License is needed to import or export.
Production or compounding (making up in the pharmacy) can be done by a pharmacist, practitioner or Liscence holder.

15

Who can schedule 2 drugs be administered to patients by

Doctor, dentist, nurse IP, pharmacist IP (independent prescriber)

16

What are schedule 3 controlled drugs? (CD No register POM)

Minor stimulants such as benzphetamine
Buprenorphine
Temazepam
Phenobarbital
Midazolam

Less overdose risk with these, less risk of misuse/ harm than with Sch 2 drugs.

17

Do schedule 2 drugs require a CD register?

Yes!!!
CD registers need to be kept for 5 years

18

Do schedule 3 drugs require a CD register?

No!
These are CD No Register POMs

19

Are there controls over destruction of Sch2 and Sch3 drugs?

There are for schedule 2 drugs,
But not for schedule 3 drugs

20

Do safe custody rules apply to schedule 2 and schedule 3 drugs?

They do for schedule 2 drugs...
But many schedule 3 drugs are exempt to safe custody requirements

21

How long should invoices (prescriptions?) of schedule 3 drugs be kept ?

Retained for 2 years
(don't need to do this for Sch 2 drugs)

22

Schedule 3 drugs have the same controls as schedule 2 drugs except....

Different groups can possess and supply
No requirements for CD register records
No MDA controls for destruction
Many are exempt from safe custody requirement

23

Schedule 4 CDs: what are the two parts and examples of drugs in those parts?

Part I (CD Benz POM): most benzodiazepines and ketamine.
Part II (CD Anab POM) anabolic and androgenic steroids, clenbuterol, growth hormones

24

Schedule 4 CDs have same restrictions/ controls as schedule 3, but what are the exceptions?

No special labelling required with Sch 4
No safe custody at all
No CD register (same as with Sch 3)
No need by law to keep invoices for 2 years

25

What are schedule 5 controlled drugs? (CD InvP or CD InvPOM)

Preparations containing CDs in low strength (eg codeine, morphine, pholcodeine)
(how much of certain drugs is in the formulation determines what schedule a drug is, Sch 5 contain low amounts of CDs)

26

What are the restrictions/ controls on Sch 5 drugs?

No MDA restrictions on import, export, possession, supply or administration
Pharmacists can make up/ compound schedule 5 drugs
Note: a drug may be contained in a schedule 2 product and also in a schedule 5 product but in lower amounts (how you manage the schedule depends on the Quantity, not just the drug!!)

27

What is the schedule of a drug determined by?

Not only the drug itself but the quantity of that drug In the Formulation. Ie you may have a schedule 2 drug and 5 drug containing the same drug such as morphine, but the schedule 5 drug will contain much lower concentrations,therefore there is less liability for abuse/ misuse
Eg: sevredol tablets containing morphine salt 10mg, a Sch 2 CD POM
Diocalm dual action tablets containing 0.4mg morphine HCL, a Sch 5 CD Inv P ☺☺

28

Are CD registers need for Sch5 CDs?

No, unless they have been made up from Sch2 drug stock (from the CD cabinet)!

29

How long should invoices be kept with Sch5 CDs?

For 2 years, as inspectors may make checks if any excessive ordering or sales are done.

Sch 5: CD Inv POM or CD Inv P

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