Controlled Drug Prescribing

The legislation of Controlled Drugs (CDs) in the UK has recently been changed 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.

Note: Pregabalin and Gabapentin are now classified as Schedule 3 CDs and as such, come under the regulations governing CDs. Further information is available on www.ggcprescribing.org.uk and search for 'Gabapentin and Pregabalin - change to CD' for Medicines Update article and memo for acute sites.

Prescription requirements for schedule 2 and schedule 3 CDs

On the discharge prescription the prescriber must ensure the following:

  • Check with pharmacy for local procedure for provision of CD prescriptions. See Appendix 6 for contact details.
  • On the discharge prescription the following details must be included (N.B. addressograph adhesive labels not allowed):
    • The patient's name, unit or CHI number and address.
    • The name, strength of the drug and form (tablets, mixture, vial, patch, etc.).
    • The total quantity of dose units (i.e. number of tablets, unit dose vials, injections, patches or volume (ml) of liquids) in words and figures.
    • The dose / time to be taken by the patient.
    • The date of the prescription.
    • The prescriber's signature.

Examples 

  • Morphine 10mg tablets: take one every four hours if required for breakthrough pain. Please supply 28 (twenty-eight) 10mg tablets.
  • Fentanyl 25microgram/hour patch: apply one patch every 72 hours. Please supply 3 (three) 25microgram patches.
  • Morphine injection 50mg subcutaneously via a syringe driver over 24 hours. Supply 10 (ten) morphine 10mg/ml amp and 5 (five) morphine 30mg/ml amp.
  • Tramadol 50mg capsules: take two capsules four times a day. Supply 56 (fifty-six) 50mg capsules.
  • Temazepam 10mg tablets: take one tablet at night. Supply 7 (seven) 10mg tablets.

Prescribers must clearly state on the prescription the quantity to be supplied of each different formulation.

The following strengths of CDs are available:

Zomorph®(Morphine MR) capsules 10mg, 30mg, 60mg, 100mg, 200mg

MST® (Morphine MR) tablets 5mg, 15mg

MST® (Morphine MR) sachets 20mg, 30mg, 60mg, 100mg, 200mg

Morphine tablets 10mg, 20mg, 50mg

Morphine injection 10mg/ml, 15mg/ml, 30mg/ml

Longtec® (Oxycodone MR) tablets 5mg, 10mg, 20mg, 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

CD prescribing – important notes

Take care with prescribing and ensure:

  • Similar sounding drugs and standard versus modified release (MR) products are written clearly to avoid misinterpretation. Common errors occur due to confusion between:
    • Oramorph® liquid and OxyNorm® liquid
    • Morphine tablets and Morphine MR tablets
    • Prescribe MR products by brand.
  • Dose prescribed is clear: E.g. 'Methadone 40ml daily' does not indicate the dose to be given.
    • On the kardex prescribe: 'Methadone 40mg daily'
    • On discharge prescription write as: 'Methadone oral solution 1mg/ml, 40ml daily'

DATIX reports show a number of incidents where millilitres and milligrams have been confused in liquid preparations.

 

Content last updated August 2019