page30
likely. This tendency is seen especially with hypno-
tics and anxiolytics (for
CSM advice see section
4.1). The prescriber should keep a close eye on the
amount prescribed to prevent patients from accu-
mulating stocks.
A minimal amount should be pre-
scribed in the first instance,
or when seeing a new
patient for the first time.
.
To avoid being used as
an unwitting source of
supply for addicts.
Methods include visiting more
than one doctor,
fabricating stories,
and forging
prescriptions.
Patients under
temporary care should be given only
small
supplies of drugs unless they present an unequi-
vocal letter from their own doctor.
Doctors should also
remember that their own patients may be attempting to
collect prescriptions from other prescribers,
especially
in hospitals.
It is sensible to reduce dosages steadily or
to issue weekly or
even daily prescriptions for
small
amounts if it is apparent that dependence is occurring.
The stealing and misuse of prescription forms could be
minimised by the following precautions:
.
do not
leave unattended if
called away from the
consulting room or at reception desks; do not leave
in a car where they may be visible; when not in use,
keep in a locked drawer within the surgery and at
home;
.
draw a diagonal
line across the blank part
of
the
form under the prescription;
.
write the quantity in words and figures when pre-
scribing drugs prone to abuse; this is obligatory for
controlled drugs (see Prescriptions,
above);
.
alterations are best avoided but if any are made they
should be
clear
and unambiguous;
add initials
against altered items;
.
if prescriptions are left for collection they should be
left in a safe place in a sealed envelope.
Travelling abroad
Prescribed drugs listed in Schedule
4 Part
II (CD Anab)
and Schedule 5 of
the Misuse of
Drugs Regulations 2001 are not
subject
to export
or
import licensing.
However,
patients intending to travel
abroad for more than 3 months carrying any amount of
drugs listed in Schedules 2, 3, or 4 Part I (CD Benz) will
require
a
personal
export/import
licence.
Further
details can be obtained at
www.homeoffice.gov.uk/drugs/licensing/personal,
or from the Home Office by contacting
licensing_enquiry.aadu@homeoffice.gsi.gov.uk
(in cases of emergency,
telephone (020) 7035 0484).
Applications must
be supported by a covering letter
from the prescriber and should give details of:
.
the patient’s name and address;
.
the quantities of drugs to be carried;
.
the strength and form in which the drugs will
be
dispensed;
.
the country or countries of destination;
.
the dates of travel to and from the United Kingdom.
Applications for licences should be sent
to the Home
Office,
Drugs
Licensing,
Peel
Building,
2 Marsham
Street,
London,
SW1P 4DF.
Alternatively,
completed
application forms can be emailed to
licensing_enquiry.aadu@homeoffice.gsi.gov.uk
with
a
scanned copy of
the covering letter from the prescri-
ber.
A minimum of
two weeks should be allowed for
processing the application.
Patients travelling for less than 3 months do not require
a personal
export/import
licence for
carrying Con-
trolled Drugs,
but
are advised to carry a letter
from
the prescribing doctor. Those travelling for more than 3
months are advised to make arrangements to have their
medication prescribed by a practitioner in the country
they are visiting.
Doctors who want
to take Controlled Drugs abroad
while accompanying patients may similarly be issued
with licences.
Licences
are not
normally issued to
doctors
who want
to take Controlled Drugs
abroad
solely in case a family emergency should arise.
Personal
export/import licences do not have any legal
status outside the UK and are issued only to comply
with the Misuse of Drugs Act and to facilitate passage
through UK Customs and Excise control. For clearance
in the country to be visited it is necessary to approach
that country’s consulate in the UK.
Notification of drug misusers
Doctors should report
cases of
drug misuse to their
regional
or national
drug misuse database or centre—
see below for contact telephone numbers. The National
Drugs
Treatment
Monitoring System (NDTMS)
was
introduced
in
England
in
April
2001;
regional
(NDTMS)
centres replace the Regional
Drug Misuse
Databases.
A similar
system has been introduced in
Wales.
Notification to regional
(NDTMS)
or
national
centre
should be made when a patient
starts treatment
for
drug misuse.
All
types of
problem drug misuse should
be reported including opioid, benzodiazepine, and CNS
stimulant.
The regional (NDTMS) or national centres are now the
only national
and local
source of
epidemiological
data
on people presenting with problem drug misuse;
they
provide valuable information to those working with drug
misusers and those planning services for
them.
The
databases
cannot,
however
be used as
a check on
multiple prescribing for drug addicts because the data
are anonymised.
Enquiries about the regional (NDTMS) or national cen-
tres (including information on how to submit data) can
be made to one of the centres listed below:
ENGLAND
Eastern
Tel:
(01223) 767904
Fax:
(01223) 330 345
South East
Tel:
(01865) 334734
Fax:
(01865) 334 964
London
Tel:
(020) 7972 1986
Fax:
(020) 7972 1998
North West
Tel:
(0151) 231 4533
Fax:
(0151) 231 4515
North East
Tel:
(0191) 334 0372
Fax:
(0191) 334 0391
Yorkshire and the Humber
Tel:
(0113) 341 2923
Fax:
(0113) 341 3082
10
Controlled Drugs and drug dependence
BNF 61
Controlled Drugs and drug dependence