Controlled Drugs information for contractors

North Midlands Controlled Drug Accountable Officer – Samantha Travis
Derbyshire, Nottinghamshire, Shropshire and Staffordshire
Email: samantha.travis@nhs.net

Tel: 0113 8254717

Generic Email: england.northmidlandscd@nhs.net 

Missed pick-up of OST medicines for three days
The NHS England (NHSE) Midlands CD Team have seen an increasing number of CD incident reports, relating to patients who have missed pick up of methadone or
buprenorphine for more than 3 days where the prescriber and/or drug treatment service had not been notified. If a patient has not taken their regular prescribed dose
of opioid, there is the possibility that their tolerance to the drug could have reduced, increasing risk of overdose if the usual dose of medication is then taken. Every
effort should be made to limit the potentially harmful impact on the patient. The pharmacist and pharmacy team have pivotal roles in the safe and effective delivery of
care.
Pharmacists are strongly advised that they or another member of the pharmacy team, must contact the prescriber / key worker / service after the third day is missed to
inform them so advice from the prescriber on what action to take can be obtained. A pharmacist should not normally dispense the fourth day’s dose unless they have
confirmed with the prescriber either to continue to dispense or to ask the patient to attend the prescribing service for an urgent clinical review.
Examples of CD Incidents and Concerns:

Pharmacies and Drug and Alcohol Teams (DAAT) should be reporting to the CDAO using the CD Reporting Portal (www.cdreporting.co.uk) –
• Patients missing doses (or receiving extra) due to dispensing, administration or prescribing errors (e.g. no stock or valid prescription)
• Patients receiving incorrect doses due to dispensing, administration or prescribing errors (e.g. incorrect quantity dispensed or prescribed)
• Doses not been given as per prescribers instructions e.g. a patient not supervised despite the prescriber requesting or not in daily doses
• Patients receiving doses from invalid / cancelled prescriptions
• Patients, pharmacy or DAAT losing prescriptions for CDs (this may include prescriptions lost in transit e.g. Royal Mail)
• Patients abusing CDs e.g. fraudulent activity / diversion / theft
• Storage, discrepancies or administration errors by DAAT
• Concerns with professionals or governance in relation to CDs
• Not reporting missed doses during titration phase
• Issues relating to discharge from hospitals / prisons and provisions for OST

Post-dated prescriptions
Prescriptions for Schedule 2, 3 and 4 CDs are only valid for 28 days. The 28 day period of validity runs from the date the prescription was signed unless the prescriber
has specified a start date on the prescription as a date before which the drugs should not be supplied. Any owing balance of prescriptions for Schedule 2, 3 or 4 CDs
cannot be dispensed later than 28 days after the appropriate date on the prescription.

CD Destructions in Community Pharmacies
The Misuse of Drugs Regulations 2001 requires premises to denature Sch 2, 3 and 4 (part 1) CDs prior to safe disposal. Usually, this process requires an appropriate
licence, but some premises for can register an exemption without needing to obtain a licence. In England, an exemption is issued by the Environment Agency and is
known as the ‘T28 exemption’. This exemption needs to be registered and updated every 3 years – Register or renew waste exemptions – GOV.UK (www.gov.uk).
Safe custody regulations apply to patient-returned CDs and expired / obsolete / unwanted CD stock until they can be destroyed appropriately. To minimise the risk of
supplying these to patients, this stock should be segregated in the CD cabinet from stock which is in use and be clearly marked (e.g. mark the stock as ‘patient returns
waiting to be destroyed’ or ‘out of date, waiting authorised witness to destroy’, etc). Please note CD stock waiting for destruction should also remain in the running
balance and appropriately balance checked regularly until destroyed. Organisations such as GP surgeries and Pharmacies in a chain of less than 5 needing an AW for
destruction should submit a request to the NHSE CD Team using the CD Reporting Portal – www.cdreporting.co.uk. If you have any queries please contact the CD
Team using the generic inbox email.

CD Reporting Portal (CDRP) – Useful Tips
Remember all CD Incidents and Concerns should be reported to the CDAO on the CDRP (www.cdreporting.co.uk) in a timely manner.
The CDRP now has separate Incident and Concern Modules.Below are definitions of Incidents and Concerns, including examples to support
reporters in which form to use. The CD Team would advise that if you are unsure which form to use please get in touch using the generic email addresses.

An Incident is defined as:

An event or situation arising in the course of work that resulted in or could have resulted in injuries, illnesses, damage to health, or fatalities. “Near miss” or “dangerous occurrence” are also terms for an event that could have caused harm but did not and these may be treated as an “Incident”.
Examples of incidents:
• Theft or diversion by healthcare professional
• Wrong dose administration of a controlled drug
• Dispensing error
• Running balance discrepancies
• Spillages / Breakages / Damaged CDS

A Concern is defined as:

A matter of interest or importance to the Controlled Drug Accountable Officer on the safe use or management of controlled drugs. Events that are yet to be corroborated or substantiated also constitute a concern. These could include a complaint or a whistleblowing report by a member of the public, healthcare professional or support staff.
Examples of concerns:
• Several reports of discrepancies that all link to one individual
• Numerous low-level events from the same provider
• Allegation – selling or receiving CDs