BNF for Children 2011-2012

BNFC 2011–2012 Prescribing Controlled Drugs 9Prescribing Controlled DrugsThe Misuse of Drugs Act, 1971 prohibits certain activitiesin relation to ‘Controlled Drugs’, in particular theirmanufacture, supply, and possession. The penaltiesapplicable to offences involving the different drugs aregraded broadly according to the harmfulness attributableto a drug when it is misused and for this purpose thedrugs are defined in the following three classes:Class A includes: alfentanil, cocaine, diamorphine(heroin), dipipanone, lysergide (LSD), methadone,methylenedioxymethamfetamine (MDMA,‘ecstasy’), morphine, opium, pethidine, phencyclidine,remifentanil, and class B substances whenprepared for injectionClass B includes: oral amfetamines, barbiturates,cannabis, cannabis resin, codeine, ethylmorphine,glutethimide, nabilone, pentazocine, phenmetrazine,and pholcodineClass C includes: certain drugs related to the amfetaminessuch as benzfetamine and chlorphentermine,buprenorphine, diethylpropion, mazindol,meprobamate, pemoline, pipradrol, most benzodiazepines,zolpidem, androgenic and anabolic steroids,clenbuterol, chorionic gonadotrophin (HCG),non-human chorionic gonadotrophin, somatotropin,somatrem, and somatropinThe Misuse of Drugs Regulations 2001 define theclasses of person who are authorised to supply andpossess controlled drugs while acting in their professionalcapacities and lay down the conditions underwhich these activities may be carried out. In the regulationsdrugs are divided into five schedules each specifyingthe requirements governing such activities asimport, export, production, supply, possession, prescribing,and record keeping which apply to them.Schedule 1 includes drugs such as cannabis andlysergide which are not used medicinally. Possessionand supply are prohibited except in accordancewith Home Office authority.Schedule 2 includes drugs such as diamorphine(heroin), morphine, nabilone, remifentanil, pethidine,secobarbital, glutethimide, amfetamine, andcocaine and are subject to the full controlled drugrequirements 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 secobarbital,now Schedule 2), buprenorphine, diethylpropion,mazindol, meprobamate, midazolam,pentazocine, phentermine, and temazepam. Theyare subject to the special prescription requirements(except for temazepam) and to the safe custodyrequirements (except for any 5,5 disubstituted barbituricacid (e.g. phenobarbital), mazindol, meprobamate,midazolam, pentazocine, phentermine, orany stereoisomeric form or salts of the above).Records in registers do not need to be kept(although there are requirements for the retentionof invoices for 2 years).Schedule 4 includes in Part I benzodiazepines(except temazepam and midazolam which are inSchedule 3) and zolpidem, which are subject tominimal control. Part II includes androgenic andanabolic steroids, clenbuterol, chorionic gonadotrophin(HCG), non-human chorionic gonadotrophin,somatotropin, somatrem, and somatropin. ControlledDrug prescription requirements do notapply (but see Department of Health Guidance,p. 10) and Schedule 4 Controlled Drugs are notsubject to safe custody requirements.Schedule 5 includes those preparations which,because of their strength, are exempt from virtuallyall Controlled Drug requirements other than retentionof invoices for two years.Prescriptions Preparations in Schedules 2, 3, and 4 ofthe Misuse of Drugs Regulations 2001 (and subsequentamendments) are identified throughout BNF for Childrenusing the following symbols:. 2 for preparations in Schedule 2;. 3 for preparations in Schedule 3;. K for preparations in Schedule 4 (Part I);. L for preparations in Schedule 4 (Part II).The principal legal requirements relating to medicalprescriptions are listed below (see also Department ofHealth Guidance, p. 10).Prescription requirementsPrescriptions for Controlled Drugs that are subjectto prescription requirements 1 must be indelible 2 andmust be signed by the prescriber, be dated, andspecify the prescriber’s address. The prescriptionmust always state:. The name and address of the patient;. In the case of a preparation, the form 3 andwhere appropriate the strength 4 of the preparation;. either the total quantity (in both words andfigures) of the preparation, 5 or the number (inboth words and figures) of dosage units, asappropriate, to be supplied; in any other case,the total quantity (in both words and figures) ofthe Controlled Drug to be supplied;. The dose; 6. The words ‘for dental treatment only’ if issuedby a dentist.A pharmacist is not allowed to dispense a ControlledDrug unless all the information required by law is givenon the prescription. In the case of a prescription for aControlled Drug in Schedule 2 or 3, a pharmacist canamend the prescription if it specifies the total quantityonly in words or in figures or if it contains minortypographical errors, provided that such amendmentsare indelible and clearly attributable to the pharmacist. 7Failure to comply with the regulations concerning the1. All preparations in Schedules 2 and 3, except temazepam.2. A machine-written prescription is acceptable. The prescriber’ssignature must be handwritten.3. The dosage form (e.g. tablets) must be included on aControlled Drugs prescription irrespective of whether it isimplicit in the proprietary name (e.g. MST Continus) orwhether only one form is available.4. When more than one strength of a preparation exists thestrength required must be specified.5. The Home Office has advised that quantities of liquidpreparations such as methadone mixture should be writtenin millilitres.6. The instruction ‘one as directed’ constitutes a dose but ‘asdirected’ does not.7. Implementation date for N. Ireland not confirmed.Prescribing Controlled Drugs