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Instalments and ‘repeats’
A prescription may order
a Controlled Drug to be dispensed by instalments;
the
amount of instalments and the intervals to be observed
must be specified.
1
Instalment
prescriptions must
be dispensed in accor-
dance with the directions in the prescription. However,
the Home Office has approved specific wording which
may be included in an instalment prescription, to cover
certain situations;
for example,
if a pharmacy is closed
on the day when an instalment is due.
For details,
see
Medicines, Ethics and Practice
,
No.
34,
London,
Phar-
maceutical
Press,
2010 (and subsequent
editions
as
available)
or
see
Drug Misuse and Dependence:
UK
Guidelines on Clinical Management
(2007), available at
www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf.
Prescriptions ordering ‘repeats’
on the same form are
not permitted for Controlled Drugs in Schedules 2 or 3.
Private prescriptions
Private prescriptions for Con-
trolled Drugs in Schedules 2 and 3 must be written on
specially designated forms provided by Primary Care
Trusts in England,
Health Boards in Scotland,
Local
Health Boards in Wales, or the Northern Ireland Central
Services Agency; in addition, prescriptions must specify
the
prescriber’s identification number
.
Prescriptions to
be supplied by a pharmacist in hospital are exempt from
the requirements for private prescriptions.
Department of
Health guidance
Guidance (June
2006) issued by the Department of Health in England on
prescribing
and
dispensing
of
Controlled
Drugs
requires:
.
in general,
prescriptions for
Controlled Drugs in
Schedules 2,
3,
and 4 to be limited to a supply of
up to 30 days’
treatment;
exceptionally,
to cover a
justifiable clinical
need and after consideration of
any risk,
a prescription can be issued for a longer
period,
but the reasons for the decision should be
recorded on the patient’s notes;
.
the patient’s identifier
to be shown on NHS and
private prescriptions for Controlled Drugs in Sche-
dules 2 and 3.
Further information is available at
www.dh.gov.uk. For a
sample prescription, see above
Dependence and misuse
The most serious drugs of
addiction are cocaine,
diamorphine
(heroin),
mor-
phine,
and the synthetic opioids.
For
arrangements
for prescribing of diamorphine,
dipipanone,
or cocaine
for addicts,
see p.
11.
Despite marked reduction in the prescribing of amfeta-
mines, there is concern that abuse of illicit amfetamine
and related compounds is widespread.
Benzodiazepines
are commonly misused.
However,
the misuse of
barbiturates is now uncommon,
in line
with declining medicinal
use and consequent availabil-
ity.
Cannabis (Indian hemp) has no approved medicinal use
and cannot be prescribed by doctors. Its use is illegal but
widespread.
Cannabis is a mild hallucinogen seldom
accompanied by a desire to increase the dose;
with-
drawal symptoms are unusual. Lysergide (lysergic acid
diethylamide, LSD) is a much more potent hallucinogen;
its use can lead to severe psychotic states which can be
life-threatening.
There are concerns over increases in the availability and
misuse of other drugs with variously combined halluci-
nogenic,
anaesthetic,
or
sedative
properties.
These
include ketamine and gamma-hydroxybutyrate (sodium
oxybate,
GHB).
Supervised consumption
Individuals
prescribed
opioid substitution therapy (section 4.10.3)
can take
their
daily dose under
the supervision of
a doctor,
nurse,
or
pharmacist
during
the
dose
stabilisation
phase (usually the first 3 months of treatment),
after a
relapse or period of instability, or if there is a significant
increase in the dose of
methadone.
Supervised con-
sumption should continue (in accordance with local
protocols)
until
the prescriber
is
confident
that
the
patient is compliant with their treatment.
Prescribing drugs likely to cause dependence or
misuse
The prescriber has three main responsibilities:
.
To avoid creating dependence by introducing drugs
to patients without sufficient reason. In this context,
the proper use of
the morphine-like drugs is well
understood. The dangers of other Controlled Drugs
are less clear because recognition of dependence is
not easy and its effects, and those of withdrawal, are
less obvious.
.
To see that the patient does not gradually increase
the dose of a drug, given for good medical reasons,
to the point
where dependence becomes
more
FP10NC0105
1.
A total
of
14 days’
treatment
by instalment
of
any drug
listed in Schedule 2 of
the Misuse of
Drugs Regulations,
buprenorphine,
and diazepam may
be
prescribed in
England.
In
England
,
forms
FP10(MDA)
(blue)
and
FP10H(MDA)
(blue)
should be used.
In
Scotland
,
forms
GP10 (peach), HBP (blue), or HBPA (pink) should be used.
In
Wales
a total of 14 days’ treatment by instalment of any
drug listed in Schedules
2–5 of
the Misuse of
Drugs
Regulations
may
be
prescribed.
In
Wales,
form
WP10(MDA) or form WP10HP(AD) should be used.
BNF 61
Controlled Drugs and drug dependence
9
Controlled Drugs and drug dependence