The committee took into account changes to the NHS and relevant legislation as well as the different ways hospitals, pharmacies and GPs manage the drugs, the restrictions on which staff can prescribe them and considerations when reviewing repeat prescriptions.

NICE’s new guidance will help health and social care professionals negotiate complex legislation and regulations to ensure they are doing all they can to care for patients being treated with controlled drugs.

The guidance may also be relevant to people who work in prisons, the police and the armed forces.

Recommendations include:

• Health professionals should provide advice and information to people prescribed medications about how to store and dispose of them safely – discuss lockable or non-lockable storage boxes, whether drugs will be accessible to others and whether the chosen storage method increases the risk of a drug-related incident.
• Health organisations should keep a record log for the supply, administration, transfer and disposal of controlled drugs.
• Pharmacists should tell patients when only part of their prescription is available. They should also tell patients when the rest will be ready and how soon they must collect it.
• Prescribe enough of a controlled drug to meet the person’s clinical needs for up to but no more than 30 days. If, under exceptional circumstances, a larger quantity is prescribed, the reasons for this should be documented in the person’s care record.

Dr Tessa Lewis, GP and chair of the guideline development group, said: “Drugs like morphine and methadone are more closely regulated because of the harm that can be caused if they are not managed safely.

“A great deal of work has been done recently to help ensure the safe use and management of controlled drugs at a local and national level. However, ongoing activity and vigilance is required to sustain the positive developments that have been achieved since the changes to the structure of the NHS took effect in 2012.

“In considering changes to legislation and to the NHS structure as well as relevant patient safety incidents, this guidance provides further clarity and good practice recommendations across most NHS settings and people’s own homes.

“Our aim with this guideline is to support organisations and individuals to minimise the potential harms associated with these medicines by having robust systems and processes in place for their use.”

A seven year review¹ of medicines-related safety incidents concerning controlled drugs in England and Wales (reported to the National Reporting and Learning System) found the risk of death was far greater than with other medications.

The report said that five commonly used controlled drugs were responsible for 113 incidents (88.4%) leading to serious harm (death and severe harm) with overdose accounting for 89 (69.5%) of the 128 incidents of serious harm.

Notes to Editors

References

1. Cousins D, Gerrett D, Warner B (2013) ‘A review of Controlled Drug incidents reported to the NRLS over seven years.’ Pharmaceutical Journal Vol 291 http://www.pharmaceutical-journal.com/in-depth/research-article/a-review-of-controlled-drug-incidents-reported-to-the-nrls-over-seven-years/11125507.article

About the guidance

1. The guidance is available from /guidance/ng46
2. NICE’s guidance applies to controlled drugs listed in Schedules 2, 3, 4 and 5 of the Misuse of Drugs Regulations 2001 –Schedule 2 drugs include morphine and methadone, Schedule 3 drugs include temazepam and Schedule 4 drugs include diazepam.