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Medicines regulation

Information must be shared more effectively to stem controlled drug abuses

Healthcare professionals are still not following the rules when handling controlled drugs.

Steve Field, first chief inspector of general practice of the Care Quality Commission (CQC)

Source: Care Quality Commission (CQC)

Steve Field says that small numbers of healthcare professionals are still supplying controlled drugs illegally

Despite measures to tighten up security, a small number of healthcare professionals are still taking controlled drugs without permission, supplying them illegally to others or misusing the drugs themselves, according to the UK government’s first chief inspector of general practice in England, Steve Field.

The abuses illustrate the need for better sharing of information about controlled drugs and the crucial role that controlled drugs accountable officers (CDAOs) have in tackling the misuse of supplies, Field says. He leads the inspection and regulation of primary care services for the Care Quality Commission (CQC), England’s regulator for health and social care.

Field’s comments follow publication of the CQC’s annual report[1] into the management of controlled drugs, published on 19 August 2014. The report, which looks at the impact of revised UK regulations governing controlled drugs introduced in April 2013, calls for more money to pay for the network of CDAOs who have taken on the role without extra funding.

The role, says the report, is often a “bolt on” to an existing job description. Working with limited resources, CDAOs either purchase services, such as pharmaceutical advice, or have to rely on the goodwill of NHS clinical commissioning groups (CCGs) or commissioning support units to carry out duties on their behalf.   

But the relationships between CDAOs and CCGs are variable and the links between them need to be strengthened so they can work together more easily, the report says.

The report also looks at the prescribing patterns for controlled drugs in 2013. The number of controlled drug items prescribed fell by 1% in primary care, although the total bill rose by 10%.

Prescriptions for temazepam fell in 2013, continuing a trend first identified in 2007. It is thought the gap will be filled by an increase in the prescribing of non-benzodiazepine hypnotics.

Since 2007, there has been an increase in the number of prescriptions for morphine sulphate, oxycodone, fentanyl, methylphenidate and midazolam. The trend continued between 2012 and 2013.

Pharmacists’ prescribing of controlled drugs increased by 16% in 2013; most prescriptions were for methadone and buprenorphine for the treatment of addiction.

Scottish government issues advice on controlled drugs

The CQC report follows new guidance released on 14 August 2014 by the Scottish government about the supervision and management of controlled drugs in Scotland. The guidance[2] explains changes to UK regulations, primarily made to reflect the new NHS structure in England but also designed to simplify the regulations and reduce any burdens.

The guidance expands the role of Healthcare Improvement Scotland (HIS) — Scotland’s regulator of healthcare providers — to maintain a register of CDAOs and to decide whether smaller organisations employing fewer than ten staff need to appoint one. Unlike in England, where the CQC will have responsibility for inspecting GP practices, CDAOs continue to have this responsibility in Scotland.

The role of the Care Inspectorate (CI) — Scotland’s regulator of social care — also changes as it takes on new responsibilities for how care homes manage their controlled drugs. It can also be asked to carry out inspections.

Community pharmacists should continue to report any incidents involving controlled drugs to the NHS CDAO, according to the guidance.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066244

Readers' comments (1)

  • Question: When is a Controlled Drug not controlled? Answer: When it is a patient's property after their death.

    When are we going to see constructive developments in the community to recover CDs from patients property once they have passed away? They are "no one's" responsibility. Uncontrolled CDs in the community represent unquantified risk.

    With increasing numbers of patients choosing and being supported to die at home in the community, this issue is likely to increase.

    Trevor Jenkins
    Community Health Services Lead Pharmacist
    SEPT CHS Bedfordshire

    Unsuitable or offensive? Report this comment

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