The legislation of Controlled Drugs (CDs) in the UK has undergone many changes in recent years in an effort to improve patient and staff safety in relation to CDs. It is essential that a complete audit trail for CDs, from their procurement by pharmacy to administration / supply to patients or their return to pharmacy and/or destruction, is maintained.
Guidance on the regulations, classification and scheduling of CDs can be found here.
Of note is that pregabalin and gabapentin, like midazolam, are now classified as Schedule 3 CDs and as such, come under the regulations governing CDs. Further information is available on www.ggcmedicines.org.uk and search in the grey box for 'Gabapentin and Pregabalin- change to CD’ to find Medicines Update blog and memo for acute sites.
More recently, Buprenorphine prolonged-release injection Buvidal® became routinely available in line with national guidance on the treatment of opioid dependence within a framework of medical, social and psychological treatment for use in adults and adolescents aged 16 years or over.
Epidyolex®, Cannabidiol, is now routinely available, under specialist approval for use as adjunctive therapy of seizures associated with Lennox-Gastaut syndrome, in conjunction with clobazam, for patients 2 years of age and older. It is classified as a Schedule 5 CD.
On the discharge prescription the prescriber must ensure the following:
Prescribers must clearly state on the prescription the quantity to be supplied of each different formulation. For example:
The following are available strengths of commonly prescribed CDs which are also included on the GGC Adult Medicines Formulary:
Zomorph®(Morphine MR) capsules 10mg, 30mg, 60mg, 100mg, 200mg
MST® (Morphine MR) tablets 5mg, 15mg
Morphine Immediate Release (IR) tablets 10mg, 20mg, 50mg
Morphine injection 10mg/ml, 15mg/ml, 30mg/ml
Oxypro® (Oxycodone MR) tablets 5mg, 10mg, 15mg, 20mg, 30mg, 40mg, 80mg
Shortec® (Oxycodone immediate release) capsules 5mg, 10mg, 20mg
Oxycodone liquid 5mg/5ml
Matrifen® (Fentanyl transdermal) patches 12, 25, 50, 75, 100micrograms
Diamorphine injection 5mg, 10mg, 30mg, 100mg, 500mg
A number of incidents have been reported involving confusion between similar sounding names and misinterpretation around standard and modified release (MR) products. DATIX reports show a number of incidents where millilitres and milligrams have been confused in liquid preparations.
For all liquid preparations:
Common errors occur due to confusion between IR and MR preparations. Oral MR opioid preparations should be prescribed by brand to minimise the risk of confusion and error in dispensing and administration.
Guideline reviewed: October 2022
Page last updated: November 2022