Controlled Drug
Encyclopedia
The United Kingdom
Misuse of Drugs Act 1971
aimed to control the possession and supply of numerous listed drugs and drug-like substances as a controlled substance
. The act allowed and regulated the use of some Controlled Drugs (designated CD) by various classes of persons (e.g. doctors) acting in their professional capacity.
In clinical practice, this mostly applies to the use of strong opiate
s for pain management
and some amphetamine
-like stimulant
s used for Attention-deficit hyperactivity disorder
; both of which are regulated under Schedule 2.
The Royal Pharmaceutical Society
maintains a live database of the legal classification of medicines.
used diamorphine to murder hundreds of his patients during the late 20th century.
and LSD
except when licenced by the Home Office to carry out research.
Cannabis when prescribed in the form of the licensed drug Sativex
is subject to the same prescription requirements under the misuse of drugs regulations as Schedule 2 drugs. Its principal active cannabinoid components still remain schedule 1 substances.
Recently, in a report published in The Lancet
Journal, researchers have introduced an alternative method for drug classification in the UK. This new system uses a “nine category matrix of harm, with an expert Delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion.” The new classification system suggested that alcohol
and tobacco
were in the mid-range of harm, while Cannabis
, LSD
, and Ecstasy were all below the two legal drugs in harmfulness.
This research is in line with a British House Of Commons
report Drug Classification: Making A Hash Of It
.
, cocaine
, methadone
, methylphenidate
, dextroamphetamine
, fentanyl and oxycodone
. Under the Act, a prescription for these drugs need to show full details including the form and strength of the preparation, with the total quantity written out in both words and figures. It is an offence for a doctor to issue an incomplete prescription or for a pharmacist to dispense a controlled drug unless all the required details are given.
It is the prescriber's responsibility to minimize the risk of dependence or misuse by ensuring that such drugs are not started for a particular patient without good cause, that the dose is not increased to the point where dependency is more likely, and to avoid being an unwitting source of supply for addicts. The quantities of controlled drugs prescribed should match the likely needs of the patients until the next clinical review and prescription forms should be secured against theft.
Requirements for safe custody in pharmacies apply to all Sch 2 Controlled Drugs except quinalbarbitone.
The safe custody requirements ensures that pharmacists and doctors holding stock of controlled drugs must store them in securely fixed double-locked steel safety cabinets and maintain a written register, which must be bound and contain separate entries for each drug and must be written in ink with no use of correction fluid. Disposal of expired stock must be witnessed by a designated inspector (either a police officer or a suitably qualified official).
Until 2005 prescriptions for most schedule 2 & 3 drugs required certain details to be handwritten by the prescriber, unless he or she held a handwriting exemption certificate. The Shipman Inquiry
however, found that this was one of the weaknesses in the audit system. Whereas computer generated prescriptions automatically left an audit trail which was easy to follow, handwritten prescriptions did not, even though all filed prescriptions are eventually sent to a central UK depositary. Therefore, good practice now calls for these prescriptions to be computer generated.
is also exempt from the rules on writing CD prescriptions; for example, it does not need quantity stated in words and figures. With the exception of phenobarbitone or related drugs for treatment of epilepsy, no Sch 3 drug can be given as an emergency supply.
Safe custody is currently only required for Tenuate Dospan (diethylpropion), buprenorphine
products, temazepam and flunitrazepam (Rohypnol). Neither phenobarbitone nor midazolam require safe custody. Other Sch 3 drugs can be stored in the general dispensary.
s (Subclass CD Benz), other than temazepam, flunitrazepam or midazolam, and androgenic and anabolic steroid
s (Subclass CD Anab). However CD Benz products- which also include mild stimulants such as mesocarb and femcamfamine, formerly prescribed as anorectics- are illegal to supply or possess without prescription and all Sch 4 drugs cannot be legally supplied without medical authority.
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
Misuse of Drugs Act 1971
Misuse of Drugs Act 1971
The Misuse of Drugs Act 1971 is an Act of Parliament which represents UK action in line with treaty commitments under the Single Convention on Narcotic Drugs, the Convention on Psychotropic Substances, and the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic...
aimed to control the possession and supply of numerous listed drugs and drug-like substances as a controlled substance
Controlled substance
A controlled substance is generally a drug or chemical whose manufacture, possession, or use are regulated by a government. This may include illegal drugs and prescription medications ....
. The act allowed and regulated the use of some Controlled Drugs (designated CD) by various classes of persons (e.g. doctors) acting in their professional capacity.
In clinical practice, this mostly applies to the use of strong opiate
Opiate
In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...
s for pain management
Pain management
Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists,...
and some amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
-like stimulant
Stimulant
Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
s used for Attention-deficit hyperactivity disorder
Attention-deficit hyperactivity disorder
Attention deficit hyperactivity disorder is a developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age.ADHD is the most commonly studied and...
; both of which are regulated under Schedule 2.
The Royal Pharmaceutical Society
Royal Pharmaceutical Society
The Royal Pharmaceutical Society is the body responsible for the leadership and support of the pharmacy profession within England, Scotland and Wales...
maintains a live database of the legal classification of medicines.
Schedules
Special responsibilities are placed upon pharmaceutical wholesalers, pharmacies and doctors in the stocking, distribution, issuing of prescriptions, supply and disposal of items listed under the first three of the schedules. The regulations have been further tightened since Dr Harold ShipmanHarold Shipman
Harold Fredrick Shipman was an English doctor and one of the most prolific serial killers in recorded history with 218 murders being positively ascribed to him....
used diamorphine to murder hundreds of his patients during the late 20th century.
Schedule 1 - CD Lic
Drugs which are not used medically, and thus their possession and supply is prohibited; e.g. cannabisCannabis
Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre , for seed and seed oils, for medicinal purposes, and as a...
and LSD
LSD
Lysergic acid diethylamide, abbreviated LSD or LSD-25, also known as lysergide and colloquially as acid, is a semisynthetic psychedelic drug of the ergoline family, well known for its psychological effects which can include altered thinking processes, closed and open eye visuals, synaesthesia, an...
except when licenced by the Home Office to carry out research.
Cannabis when prescribed in the form of the licensed drug Sativex
Sativex
Nabiximols is a cannabinoid oromucosal mouth spray developed by the UK company GW Pharmaceuticals for multiple sclerosis patients, who can use it to alleviate neuropathic pain, spasticity, overactive bladder, and other symptoms. Nabiximols is also being developed in Phase III trials as a...
is subject to the same prescription requirements under the misuse of drugs regulations as Schedule 2 drugs. Its principal active cannabinoid components still remain schedule 1 substances.
Recently, in a report published in The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
Journal, researchers have introduced an alternative method for drug classification in the UK. This new system uses a “nine category matrix of harm, with an expert Delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion.” The new classification system suggested that alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
and tobacco
Tobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
were in the mid-range of harm, while Cannabis
Cannabis
Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre , for seed and seed oils, for medicinal purposes, and as a...
, LSD
LSD
Lysergic acid diethylamide, abbreviated LSD or LSD-25, also known as lysergide and colloquially as acid, is a semisynthetic psychedelic drug of the ergoline family, well known for its psychological effects which can include altered thinking processes, closed and open eye visuals, synaesthesia, an...
, and Ecstasy were all below the two legal drugs in harmfulness.
This research is in line with a British House Of Commons
British House of Commons
The House of Commons is the lower house of the Parliament of the United Kingdom, which also comprises the Sovereign and the House of Lords . Both Commons and Lords meet in the Palace of Westminster. The Commons is a democratically elected body, consisting of 650 members , who are known as Members...
report Drug Classification: Making A Hash Of It
Drug Classification: Making A Hash Of It
Drug classification: making a hash of it? is the title of a report authored by the UK Science and Technology Select Committee and submitted to the British House of Commons. It was published in July 2006...
.
Schedule 2 - CD
Substances subject to the full controlled drug requirements; e.g. diamorphine (heroin), pethidinePethidine
Pethidine or meperidine Pethidine (INN) or meperidine (USAN) Pethidine (INN) or meperidine (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in Indonesia); Petidin Dolargan (in Poland);...
, cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
, methylphenidate
Methylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
, dextroamphetamine
Dextroamphetamine
Dextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus as well as decreased fatigue and decreased appetite....
, fentanyl and oxycodone
Oxycodone
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...
. Under the Act, a prescription for these drugs need to show full details including the form and strength of the preparation, with the total quantity written out in both words and figures. It is an offence for a doctor to issue an incomplete prescription or for a pharmacist to dispense a controlled drug unless all the required details are given.
It is the prescriber's responsibility to minimize the risk of dependence or misuse by ensuring that such drugs are not started for a particular patient without good cause, that the dose is not increased to the point where dependency is more likely, and to avoid being an unwitting source of supply for addicts. The quantities of controlled drugs prescribed should match the likely needs of the patients until the next clinical review and prescription forms should be secured against theft.
Requirements for safe custody in pharmacies apply to all Sch 2 Controlled Drugs except quinalbarbitone.
The safe custody requirements ensures that pharmacists and doctors holding stock of controlled drugs must store them in securely fixed double-locked steel safety cabinets and maintain a written register, which must be bound and contain separate entries for each drug and must be written in ink with no use of correction fluid. Disposal of expired stock must be witnessed by a designated inspector (either a police officer or a suitably qualified official).
Until 2005 prescriptions for most schedule 2 & 3 drugs required certain details to be handwritten by the prescriber, unless he or she held a handwriting exemption certificate. The Shipman Inquiry
The Shipman Inquiry
The Shipman Inquiry was the report produced by a British governmental investigation into the activities of general practitioner and serial killer Harold Shipman. Shipman was caught in 1998 and the inquiry commenced after his trial in 2000. It released its findings in various stages, with its sixth...
however, found that this was one of the weaknesses in the audit system. Whereas computer generated prescriptions automatically left an audit trail which was easy to follow, handwritten prescriptions did not, even though all filed prescriptions are eventually sent to a central UK depositary. Therefore, good practice now calls for these prescriptions to be computer generated.
Schedule 3 - CD No Reg
Include drugs subject to the same prescription requirements as Schedule 2 drugs, but without the requirement to maintain registers. TemazepamTemazepam
Temazepam is an intermediate-acting 3-hydroxy benzodiazepine. It is mostly prescribed for the short-term treatment of sleeplessness in patients who have difficulty maintaining sleep...
is also exempt from the rules on writing CD prescriptions; for example, it does not need quantity stated in words and figures. With the exception of phenobarbitone or related drugs for treatment of epilepsy, no Sch 3 drug can be given as an emergency supply.
Safe custody is currently only required for Tenuate Dospan (diethylpropion), buprenorphine
Buprenorphine
Buprenorphine is a semi-synthetic opioid that is used...
products, temazepam and flunitrazepam (Rohypnol). Neither phenobarbitone nor midazolam require safe custody. Other Sch 3 drugs can be stored in the general dispensary.
Schedule 4
Controlled drug prescription requirements and safe custody requirements do not apply. Included drugs are BenzodiazepineBenzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s (Subclass CD Benz), other than temazepam, flunitrazepam or midazolam, and androgenic and anabolic steroid
Steroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
s (Subclass CD Anab). However CD Benz products- which also include mild stimulants such as mesocarb and femcamfamine, formerly prescribed as anorectics- are illegal to supply or possess without prescription and all Sch 4 drugs cannot be legally supplied without medical authority.