Misuse of drugs act

Why are drugs controlled?

• they can be abused and misused

• they can be dangerous and have the potential to cause harm

• some have an established or emerging patterns of non medical use

• misuse of drugs can have a wider social impact

What is the act that creates the laws around controlled drugs?

Misuse of Drugs Act 1971

What are designated as controlled drugs?

dangerous or otherwise harmful drugs

What does the act around controlled drugs do?

prohibits the possession, supply, manufacture, import and export of all controlled drugs

What does the misuse of drugs regulations 2001 do?

provides exceptions to the restrictions of the act around controlled drugs so that controlled drugs can be used in medicine under certain conditions

What drugs are controlled?

• narcotics

• cocaine

• amphetamines

• psychotropic drugs

• barbiturates

• benzodiazepines

• anabolic steroids

What are classes of controlled drugs dealing with?

levels of penalty

What are schedules of controlled drugs?

refers to the level of control of the drug

What is the other name for schedule 1?

CD Lic (CD licence)

What makes a drug a schedule 1?

they have little or no medical value but cause social problems due to misuse

What are the restrictions around schedule 1 drugs?

a licence from the home secretary is necessary to possess, produce, supply, offer to supply, administer or cause these drugs to be administered this includes practitioners

What are the two exceptions where a pharmacist can take possession of a schedule 1 CD without a licence?

• taking possession of a CD for the purpose of destruction

• taking possession of a CD for the purpose of handing it over to a police officer

• you should maintain patient confidentiality unless there is a suspiciously large quantity (potentially dealing drugs) then you report it to the police

What is the other name for schedule 2?

CD POM

What are the restrictions around schedule 2 drugs?

a licence is needed to import or export them, a pharmacist may supply them to a patient only on the authority of a prescription in the required form, issued by an appropriate practitioner, sale/supply recorded in the CD register

Where must schedule 2 drugs be stored?

in the controlled drugs cabinet except quinalbarbitone

What is keeping a CD in a CD cabinet called officially?

safe custody

Where must schedule 3 drugs be stored?

in the CD cabinet unless they are specifically exempt

When do the laws around safe custody not apply?

when the CDs are under the direct personal supervision of the pharmacist

What are schedule 3 drugs also known as?

CD No Reg

What are schedule 3 drugs?

drugs that are less likely to be misused than schedule 2 CDs and if they are misused they are less likely to be harmful

What schedule 3 drugs are not exempt from safe custody laws?

temazepam, diethylpropion, buprenorphine, flunitrazepam, any new drug added to schedule 3 unless specifically exempt

What is part I of schedule 4 CDs known as?

CD Benz POM

What is part II of schedule 4 CDs?

CD Anab POM

What are schedule 5 CDs known as?

CD Inv

What are the restrictions on schedule 5 controlled drugs?

no restrictions on import, export, possession, and administration, no safe custody or CD register required, invoice (or copy) must be kept for 2 years, may be manufactured and compounded by a practitioner, pharmacist acting as one or licence holder, no authority needed for destruction, no special labelling requirements

What are a large number of schedule 5 CDs?

dilute preparations of drugs found in schedule 2

What is required for the prescription of a schedule 2 or 3 CD?

• signed by the person issuing it

• be dated

• be written so as indelible

• specify the dose to be taken

• if a private prescription it needs to be on a standardised form

• if it is a private prescription for human use, it should contain the private prescriber’s identification number

• for preparations, the form and strength

• either the total quantity of the preparation or the number of dosage units (in both words and figures)

• if prescribed by a dentist it must state for dental treatment only

• specify name and address of patient

• name and address of the prescriber must be in the UK

Do schedule 2 and 3 CDs have to be written in the handwriting of the prescriber?

no

What are the rules around technical errors on CD prescriptions?

a supply of a CD can be made if: there is a minor typographical error, a minor spelling mistake, the total quantity of the preparation or number of dosage units is not specified on the prescription in either words or figures (not both). Provided that: you are satisfied that the prescription is genuine, we are acting in accordance of the practitioner, the pharmacist amends the prescription in indelible ink in a way that shows they have amended it

What are the requirements of a collection of CD by a messenger?

they must produce to the supplier a statement in writing given by the recipient to the effect that the messenger is empowered to receive the drugs on their behalf, it must be signed and dated, the pharmacist must be satisfied that it is genuine and retain it for 2 years,

Is a carrier engaged by the pharmacy counted as a messenger?

no

How is the CD register organised?

• each form has a received and supply section

• a separate form for each drug class, brand, strength and form (these are written at the top of the form)

What information is included on the CD form for a supply?

• name and address of patient

• details of authority to possess (name and address of prescriber)

• person who collected the drug

• whether proof of identity was requested and what it was - don’t legally have to do this but its good practice if you don’t know the patient

• quantity of drug

• balance (quantity of drug left)

What schedule of drug needs to be recorded on the CD register?

2

For how many days should (good practice) you provide a supply of a schedule 2,3 or 4 control drug (in one go)? Why?

up to 30, you don’t want a large quantity outside the pharmacy, can cause addiction if taken for a long time

What does a professional need in order to obtain schedule 2 and 3 controlled drugs for professional purposes (stock in clinic, research, care homes, etc.)?

a requisition (signed order) in writing

What are the requirements for a requisition in writing?

• needs to be on a CD requisition form

• signed by the recipient

• recipients name and address

• recipients profession or occupation

• total quantity of CD

• purpose for which the CD is required

What drugs are included in the opioids group?

morphine, codeine, papaverine, and noscapine

What are opioids (drug classification)?

analgesics

What is heroin?

diamorphine (diacetylmorphine), it is semi-synthetic and derived from morphine, it is twice as potent as morphine, it is a schedule 2 drug, powerful analgesic drug used a lot in end of life care, only small amounts are given

Why is illegal heroine so dangerous?

unknown amount of active diamorphine so easy to overdose, some non soluble components can be present and these can block your blood vessels which can cause tissue narcosis, sharing needles can cause the spread of blood born viruses

What is cocaine?

used to be used for local anaesthetics but changed the structure now, it’s an alkaloid, hydrochloride is usually inhaled nasally through a short tube, alkaloid base is more stable so smoked or heated and the vapour is inhaled

What harmful effects does cocaine cause?

hangover effect next day, acidic salts can cause damage to nasal mucosa eventually causing destruction of the nasal tissue

What are amfetamines?

a few can be used to trat narcolepsy or ADHD, should not be used to treat depression, obesity, or relief of fatigue. methamphetamine can be snorted, smoked, taken orally, or injected, crystalised to make pure and more potent. 3,4-Methylenedioxymethamphetamine (MDMA) is taken orally. can be made from pseudoephedrine so it is on the watch list of substances liable to misuse

What are benzodiazepines?

lots are available on prescription for anxiety under certain strict circumstances, people who have been prescribed benzodiazepines can become dependant on them

When can you prescribe benzodiazepines?

for the short term relief (2-4 weeks) of anxiety that is severe, disabling or subjecting the individual to unacceptable stress, occurring alone or with other related conditions, insomnia when it is severe, disabling or subjecting the individual to unacceptable stress

How are benzodiazepines misused?

when taken in high doses and when injected can produce a high, abuse of temazepam is quite common used to come in liquid capsules so easy to inject - this was changed to a gel capsule to prevent misuse this didn’t work so all capsules are band, widely available illegally and cheap, alleviate withdrawal effects, extend high from opioids, dangerous in overdose - take more if been taking stimulants during the day and with alcohol

What problems did gel filled temazepam capsules cause when misuse

heated to turn into liquid then injected, this gel solidifies in the blood and blocks blood vessels so filled capsules are band

What is cannabis?

a schedule 1 controlled drug as a gel or plant containing cannabinoids, THC is the most common and can be used as a medicinal product

What are magic mushrooms?

mushrooms that produce hallucinogenic effects, no medicinal use, toxicity by misidentification

What are Legal highs?

drugs sold online not for human consumption, slightly modified to make them not controlled drugs so their production is legal, unknown ingredients, dose and no quality assurance

What is harm reduction?

something intended to reduce the adverse effects of drug misuse as far as possible until the misuser has decide, or is able, to stop misusing the drug

What are the three principles of harm reduction?

1. the misuse of drugs is accepted but not approved of

2. the user should be treated as a normal human being

3. harm reduction need not necessarily lead to the longer term goal of ridding the world of drug misuse

What are the controversies of harm reduction?

• it does not focus on abstinence

• maintenance therapy - do they abuse their treatments

• attitudes of some pharmacists

• costs of drug services

• government targets distorting clinical priorities?

How are pharmacists involved in harm reduction?

• needle exchange - clean needles given, dirty needles disposed of safely - prevents blood born viruses spreading to other users and the public

• instalment dispensing - dispensing the medication everyday to prevent them getting large quantities of the drugs, replacement therapy

• methadone supply and supervised administration

• nicotine replacement therapy (NRT)