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Taking proper care of 'controlled drugs'

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01 April 2009, at 12:00am

John Gerrard reviews the legislation on controlled drugs and how it affects veterinary surgeons

The law on controlled drugs is based on the UN Conventions on Narcotic Drugs 1961 and Psychotropic Substances Convention 1971 and is set out in the Misuse of Drugs Act 1971 and associated Regulations (mainly the Misuse of Drugs Regulations 2001).

 The purpose of the legislation is to prevent diversion of licit controlled drugs to the illicit market and to prevent misuse. It is not designed to prevent doctors, veterinary surgeons, pharmacists and dentists accessing drugs they need in the treatment of humans and animals.

 Following recommendations of the Shipman Inquiry, additional tighter controls have been put in place to ensure the safe use and management of controlled drugs.

 Although in the Regulations there are specific references to the rights of veterinary surgeons, namely in relation to prescription writing requirements and the receipt of drugs returned by clients for destruction, the generic term “practitioner” is used throughout the legislation which is defined in the Act as including veterinary surgeons.

 Controlled drugs are classified into five schedules which accord different levels of control. A veterinary surgeon acting in his capacity as such has the authority to prescribe, administer, possess and supply those in Schedules 2-5.

 Schedule 2 drugs include etorphine, fentanyl, morphine, pethidine, methadone and secobarbital (quinalbarbitone). These drugs are subject to particular requirements in relation to prescription writing, requisitions, record keeping, and safe custody [except secobarbital (quinalbarbitone)] and destruction/disposal of them.

Requisitions required

 Schedule 3 drugs include the other barbiturates such as butobarbital, pentobarbital, phenobarbital as well as temazepam, pentacocine and buprenorphine.

 Of those drugs, only temazepam and buprenorphine are subject to safe custody but requisitions are required when obtaining supplies of any drugs in the Schedule from the practice’s wholesaler.

 Ketamine is included in Schedule 4 along with other benzodiazepines and the RCVS recommends that Ketamine is stored in the controlled drugs cabinet and that an informal record is made of its use. Schedule 5 includes weaker preparations of Schedule 2 drugs and is subject to the lowest level of control which includes some overthe-counter products.

 The law requires that those drugs subject to safe custody must be kept in a locked receptacle so constructed and maintained as to prevent unauthorised access to the drugs.

RCVS guidance 

The RCVS has issued guidance setting out the factors to be taken into account in determining who should have authorised access to the controlled drugs cabinet.

 These include employment or other references, any relevant criminal convictions, any health problems, length of time with the practice and whether the person is ever likely to be alone in the premises or able to gain access to drugs on open shelves.

 The controlled drugs register must be a bound book and does not include any form of loose leaf register or card index. The Regulations set out the minimum requirements of the information to be included in the controlled rugs register but they do not prevent the inclusion of additional but related information such as running balances.

 Veterinary practices are required by law to record the date the supply is received and from whom as well as the date supplied, person and quantity supplied and details of the prescriber.

 Following on from the Shipman Inquiry, additional record keeping requirements have been introduced. These additional requirements relate to the collection of the drugs and the identification of the person doing so.

 This is not a problem with veterinary practices as almost exclusively the controlled drugs are used in-house, unlike dispensing doctor practices where patients take them home with, therefore, more scope for diversion and misuse.

 In a veterinary practice those columns should be used to identify the animal involved and the animal’s owner.

Vicarious liability 

The Act and Regulations do not specify how unwanted controlled drugs should be destroyed but the Royal Pharmaceutical Society of Great Britain offers guidance on how for different preparations but there is vicarious liability if controlled drugs are disposed of in an unsafe or reckless manner under various other statutes and common law.

 For the purposes of the Misuse of Drugs legislation, a drug is deemed to have been destroyed if it has been denatured to the extent that it cannot be retrieved, re-constituted and re-used.

 The destruction of a veterinary practice’s stock of Schedule 2 controlled drugs must be witnessed by an authorised person. Currently police officers are so authorised but it may be that other persons who will be undertaking inspections of veterinary practices as a result of the proposed veterinary premises registration scheme should be so authorised. This would overcome any problem in arranging for a witness to attend.

 In the case of dispensing doctor practices, they are statutorily required to have standard operating procedures in place covering different aspects of the safe use and management of controlled drugs. The RCVS has recommended that veterinary practices have similar operating procedures covering such issues as where the controlled drugs are stored, who has access to the controlled drugs cabinet and those stored on open shelves, management of the cabinet’s keys, destruction and disposal of unwanted controlled drugs and record keeping.