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Controlled drugs

Controlled drugs prescribed by pharmacists almost doubled last year

Royal Pharmaceutical Society attributes increase to more pharmacists being trained to prescribe.

Roger Knaggs

Courtesy of Roger Knaggs

Roger Knaggs, Royal Pharmaceutical Society spokesperson on pain, says that all pharmacists prescribing opioids “need to be aware … that the evidence of effectiveness in long-term pain is very limited”

Controlled drug prescribing by pharmacists almost doubled in 2016, according to a report by the Care Quality Commission (CQC).

The independent health regulator’s ‘The Safer Management of Controlled Drugs’ annual update found that the number of controlled drugs prescribed by pharmacists rose from 127,547 items in 2015 to 253,683 in 2016. Nurse prescribing in the same year rose by just 5%.

The main controlled drugs prescribed by pharmacists were co-codamol, tramadol and codeine according to the report.

Royal Pharmaceutical Society (RPS) spokesperson on pain, associate professor in clinical pharmacy practice at the University of Nottingham and an advanced pharmacy practitioner in pain management, Roger Knaggs, said the increase was most likely due to the increasing number of pharmacists undertaking training to become prescribers.

“No doubt the recent development of pharmacists working clinically in GP surgeries will have increased prescribing as long-term conditions are one area that pharmacists are often focusing on,” he said.

“The fairly consistent increase in prescribing for all controlled drugs listed suggest that the increase is related to increasing numbers of prescribers.”

He advised that all pharmacists prescribing opioids “need to be aware that while they may be very beneficial for acute pain and at the end of life, the evidence of effectiveness in long-term pain is very limited.

“All pharmacist prescribing opioids should be familiar with best practice guidance, such as Opioids Aware,” Knaggs said.

Review patients regularly

The CQC recommended that prescribers of controlled drugs must make sure that they review patients regularly, depending on their clinical need.

“This is to ensure that the prescribed controlled drugs and length of treatment continues to be the most appropriate for their condition and to reduce opportunities for over-prescribing and diversion,” it said.

The CQC report also highlighted “an increasing number of incidences of healthcare staff diverting or misusing controlled drugs”.

The CQC said controlled drug accountable officers — who have responsibility for all aspects of controlled drugs management within their organisation — “should ensure all staff in their organisation know how to report concerns about diversion and abuse of medicines by fellow colleagues” and that these issues are handled “sensitively and appropriately.”

The CQC update also recommended that NHS England controlled drug accountable officers should be aware of new models of care across their area. “We are seeing new and innovative ways of providing healthcare, and these changes have resulted in a new range of healthcare service providers with controlled drugs responsibilities.

“It is therefore important that these organisations are included within the wider controlled drugs local intelligence networks,” the report stated.

The regulator said it would “continue to monitor the trend in prescribing of controlled drugs by non-medical prescribers”.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20203253

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