COVID-19: urgent supplies of Controlled Drugs

COVID-19: urgent supplies of Controlled Drugs

March 31, 2020

The COVID-19 pandemic is increasing the number of requests patients are making to pharmacies for emergency supplies of medicines. Where appropriate, these requests may be dealt with via a patient funded emergency supply, a referral to their general practice or the Community Pharmacist Consultation Service (CPCS).

Pharmacists who receive requests from a patient for an emergency supply or CPCS referrals for urgent supplies should use their professional judgement to determine whether an emergency supply is appropriate and legal to make. If it is not, the patient may need to be escalated to the GP OOH service or signposted to their own GP practice. Particular care should be taken when deciding to supply any medicine that has a potential for misuse.

The Human Medicines Regulations 2012 (HMR) set out the maximum quantity of a POM that can be supplied as an emergency supply. Professional judgement should be used to supply a reasonable quantity that is clinically appropriate, particularly where the requested medicine is liable to misuse.

To make sure urgent medicines supplies for Controlled Drugs are provided appropriately, please remember that:

  • Emergency supplies of Schedule 2 and Schedule 3 Controlled Drugs are not permitted by the HMR, with the exception of phenobarbitone or phenobarbital sodium for the treatment of epilepsy;
  • Temazepam, gabapentin, pregabalin and tramadol are all Schedule 3 Controlled Drugs.  Emergency supplies of these medicines are not allowed;
  • Medicines such as benzodiazepines (apart from temazepam, which is Schedule 3), zopiclone, and zolpidem are Schedule 4 Controlled Drugs. Up to five days’ treatment may be supplied, if it is clinically appropriate and after an assessment has been made of the risk that the patient is using the emergency supply route or the CPCS to inappropriately gain additional supplies;
  • Medicines such as dihydrocodeine and codeine containing products (including co-codamol 30mg/500mg) are Schedule 5 Controlled Drugs. Up to five days’ treatment may be supplied if it is clinically appropriate and after an assessment has been made of the risk that the patient is using the emergency supply route or the CPCS to inappropriately gain additional supplies.
  • Where the legislation does permit an emergency supply, it limits the supply to a maximum of 5 days for Controlled Drugs;
  • Some CCGs have issued guidelines to local GP OOH services on the supply of medicines liable to misuse. Whilst it is for the pharmacist to determine whether a supply is appropriate, they should check if any such local guidelines are in place. The pharmacist needs to balance the potential for misuse versus the need and the impact on the patient of not supplying a medicine. A limited supply of up to 5 days treatment, until the GP practice reopens, may be appropriate. It is particularly important to check the patient’s NHS Summary Care Record for such requests, as part of the assurance that the patient has been prescribed it before and that there has not been a recent supply made;
  • A GP OOH service will only prescribe medicines liable to misuse in limited circumstances and will not usually prescribe medicines such as methadone or buprenorphine. If the pharmacist decides not to make a supply for a medicine liable to misuse, they should consider advising the patient to wait until they can collect their usual prescription from their GP practice or usual pharmacy, rather than referring them to the GP OOH service.

 

 



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