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Controlled Drugs and drug dependence
The Misuse of Drugs Act,
1971 prohibits certain activ-
ities in relation to ‘Controlled Drugs’, in particular their
manufacture,
supply,
and possession.
The
penalties
applicable to offences involving the different drugs are
graded broadly according to the
harmfulness attributa-
ble to a drug when it is misused
and for this purpose the
drugs are defined in the following three classes:
Class A includes:
alfentanil,
cocaine,
diamorphine
(heroin),
dipipanone,
lysergide (LSD),
methadone,
methylenedioxymethamfetamine
(MDMA,
‘ecstasy’),
morphine,
opium,
pethidine,
phencycli-
dine,
remifentanil,
and class
B substances when
prepared for injection
Class B includes:
oral
ampfetamines,
barbiturates,
cannabis,
cannabis resin,
codeine,
ethylmorphine,
glutethimide,
nabilone,
pentazocine,
phenmetra-
zine,
and pholcodine
Class C includes: certain drugs related to the amfe-
tamines such as benzfetamine and chlorphenter-
mine,
buprenorphine,
diethylpropion,
mazindol,
meprobamate,
pemoline,
pipradrol,
most
benzo-
diazepines, zolpidem, androgenic and anabolic ster-
oids,
clenbuterol,
chorionic gonadotrophin (HCG),
non-human chorionic gonadotrophin,
somatotro-
pin,
somatrem,
and somatropin
The
Misuse
of
Drugs
Regulations
2001 define
the
classes of
person who are authorised to supply and
possess controlled drugs while acting in their
profes-
sional
capacities and lay down the conditions under
which these activities may be carried out. In the regula-
tions drugs are divided into five schedules each specify-
ing
the
requirements
governing
such
activities
as
import,
export,
production,
supply,
possession,
pre-
scribing,
and record keeping which apply to them.
Schedule 1 includes drugs such as cannabis and
lysergide which are not
used medicinally.
Posses-
sion and supply are prohibited except in accordance
with Home Office authority.
Schedule 2 includes drugs such as diamorphine
(heroin),
morphine,
nabilone,
remifentanil,
pethi-
dine,
secobarbital,
glutethimide,
amfetamine,
and
cocaine and are subject to the full
controlled drug
requirements relating to prescriptions, safe custody
(except for secobarbital), the need to keep registers,
etc.
(unless exempted in Schedule 5).
Schedule 3 includes the barbiturates (except seco-
barbital,
now Schedule 2),
buprenorphine,
diethyl-
propion,
mazindol,
meprobamate,
midazolam,
pentazocine,
phentermine,
and temazepam.
They
are subject to the special prescription requirements
(except
for
temazepam)
and to the safe custody
requirements (except for any 5,5 disubstituted bar-
bituric acid (e.g.
phenobarbital),
mazindol,
mepro-
bamate,
midazolam,
pentazocine,
phentermine,
or
any stereoisomeric form or
salts
of
the above).
Records
in
registers
do
not
need
to
be
kept
(although there are requirements for the retention
of invoices for 2 years).
Schedule 4 includes
in Part
I
benzodiazepines
(except
temazepam and midazolam,
which are in
Schedule 3)
and zolpidem,
which are subject
to
minimal
control.
Part
II
includes androgenic and
anabolic steroids, clenbuterol, chorionic gonadotro-
phin (HCG),
non-human chorionic gonadotrophin,
somatotropin,
somatrem,
and somatropin.
Con-
trolled
drug
prescription
requirements
do
not
apply and Schedule 4 Controlled Drugs are not
subject to safe custody requirements.
Schedule 5 includes
those
preparations
which,
because of their strength, are exempt from virtually
all Controlled Drug requirements other than reten-
tion of invoices for two years.
Prescriptions
Preparations in Schedules 2 and 3 of the
Misuse of
Drugs
Regulations
2001 (and subsequent
amendments)
are identified throughout
the BNF by
the symbol
C (Controlled Drug).
The principal
legal
requirements relating to medical prescriptions are listed
below (see also Department of Health Guidance,
p.
9).
Prescription requirements
Prescriptions for Controlled Drugs that are subject
to prescription requirements
1
must
be indelible,
2
and must
be
signed
by the prescriber,
be dated,
and specify the prescriber’s
address
.
The prescrip-
tion must always state:
.
the name and address of the patient;
.
in the case of
a preparation,
the form
3
and
where appropriate the strength
4
of the prepara-
tion;
.
either
the total
quantity (in both words
and
figures)
of
the preparation,
5
or the number (in
both words
and figures)
of
dosage units,
as
appropriate,
to be supplied;
in any other case,
the total quantity (in both words and figures) of
the Controlled Drug to be supplied;
.
the dose;
6
.
the words ‘for dental treatment only’ if issued by
a dentist.
A pharmacist is not allowed to dispense a Controlled
Drug unless all the information required by law is given
on the prescription.
In the case of
a prescription for a
Controlled Drug in Schedule 2 or 3,
a pharmacist can
amend the prescription if it specifies the total
quantity
only in words
or
in figures
or
if
it
contains
minor
typographical
errors,
provided that
such amendments
are indelible and clearly attributable to the pharmacist.
Failure to comply with the regulations concerning the
writing of
prescriptions will
result in inconvenience to
patients and delay in supplying the necessary medicine.
A prescription for a Controlled Drug in Schedules 2,
3,
or 4 is valid for 28 days from the date stated thereon.
7
1.
All preparations in Schedules 2 and 3,
except temazepam.
2.
A machine-written prescription is
acceptable.
The pre-
scriber’s signature must be handwritten.
3.
The dosage form (e.g.
tablets)
must
be included on a
Controlled Drugs prescription irrespective of whether it is
implicit
in the proprietary name (e.g.
MST Continus
)
or
whether only one form is available.
4.
When more than one strength of
a preparation exists the
strength required must be specified.
5.
The Home Office has
advised that
quantities
of
liquid
preparations,
such as methadone oral
solution,
should be
written in millilitres.
6.
The instruction ‘one as directed’ constitutes a dose but ‘as
directed’ does not.
7.
The prescriber may forward-date the prescription; the start
date may also be specified in the body of the prescription.
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Controlled Drugs and drug dependence
BNF 61
Controlled Drugs and drug dependence