The purpose of this policy is to provide guidance for doctors, nurses, and patients to enable safe prescribing of controlled drugs (CDs). Incorrect prescribing of these medicines can result in harm to patients including addiction, physical and mental harm, and death. Medical opinions on these drugs has changed dramatically over the past 10 years, and what were commonly prescribed drugs are now known to be ineffective in the long term and cause serious side effects such as addiction, depression and risk of death. NICE (The National Institute for Clinical Excellence) now specifically advises doctors NOT to prescribe the vast majority of these drugs to people suffering with long term pain disorder (published 2021).
Controlled drugs also are also commonly used for recreation, abuse, and diversion, presenting an unacceptable risk to the population.
These include but are not limited to:
- Morphine
- Diazepam
- Tramadol
- Temazepam
- Codeine
- Alprazolam
- Dihydrocodeine
- Pregabalin
- Oxycodone
- Gabapentin
- Fentanyl
- Zopiclone
- Buprenorphine
- Zolpidem
This Practice will not start anybody on the above drugs for long term conditions or increase the dose for those already taking them.
New patients to the surgery who are already on these drugs long term will be invited to be reviewed and will be expected to engage with the surgery in reducing their doses in a controlled manner. We recognise patients may have been prescribed these before guidelines were changed, or by clinicians that do not adhere to national guidelines, however at this practice we believe in safely prescribing based on the evidence and guidelines we have now.
Patients who request these medicines before they are due or who run out because they have increased the dose without discussing with a Doctor will have their prescription rejected.
Controlled Drugs are limited to 30 days maximum supply at a time. It is very common for this to be limited to weekly or even daily dispense to new patients we do not know or patients where there have been concerns over their usage.
Lost Medications – Controlled Drugs
If a patient contacts the surgery saying they have lost their controlled drug medication for the first time, it is up to the on call doctor as to whether more should be issued. Reception will place a note stating “CD early request, first, *insert date*” on the patient’s alerts.
If a patient contacts the surgery again saying they have lost their CD medications their prescriptions will be changed to weekly and they will not be issued with more medication. Reception will place a note stating “CD early request, multiple” on the patient’s alerts.
If a patient on weekly prescriptions contacts the surgery saying they have lost their CD medications, their prescriptions will be changed to daily prescriptions and they will not be issued with more medication.