Misuse of drugs 2 - Lecture notes 2 PDF

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Abuse and misuse of drugs. Classification of controlled drugs, Classification under Misuse of Drugs Regulations 2001, Controls under MoD Regulations 2001, Controlled drug register....

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Misuse of drugs 2 Abuse – Deliberately using the drug outside of its licence to achieve an inappropriate aim. Misuse - Use of the drug in an inappropriate, but perhaps well-intentioned way. o Higher than recommended dose o Longer than recommended treatment used Regulations of drugs of misuse –  Misuse of Drugs Act 1971  Misuse of Drugs Regulations 2001 Misuse of Drugs Act 1971 –  Primary purpose is to prevent the misuse of controlled drugs.  Achieves this by imposing a total prohibition on the possession, supply, manufacture, import/export of controlled drugs except : o As allowed by the Misuse of Drugs Regulations 2001 OR o Under a Home Office license issued by the Secretary of State  Consolidated & extended previous legislation surrounding dangerous/harmful drugs (Controlled Drugs – CD).  Designed to deal with the control & treatment of addiction & promote education & research relating to drug dependence. Objectives of the Act –  Control of misuse  Categorise drugs  Control of trading & production  Control of possession & trafficking  Surveillance  Flexibility of approach  Education, treatment & rehabilitation  Control of prescribing & supply Advisory Council on the Misuse of Drugs (ACMD) –  Make recommendations to Government on control of dangerous drugs (classification & schedule).  Keeps under review the situation in UK & advises the relevant Ministers on matters like o 

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Restrict availability of such drugs/supervise arrangements for their supply Enable people affected by the misuse of drugs to obtain proper advice

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Secure the provision of facilities & services for their treatment, rehabilitation & aftercare.

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Promotes co-operation between the professional & community services which deal with social problems. Educate the public (especially the young) in the dangers of drug misuse. Promote research into drug misuse, its prevention/ social problems of drug misuse.

Classification of controlled drugs – 2 methods – 1. Under Misuse of Drugs Act 1971 o Classified according to potential for harm o Classified in classes

2. Under Misuse of Drugs Regulations 2001 o Classified according to their use in medicine & potential for misuse o Classified in schedules Classification under MoD Act 1971 –  Substances classified under the Act are known as controlled substances.  Classified on basis of decreasing order of harmfulness  Classification solely for the purpose of determining penalties  3 classes (A, B & C) Class  Class  Class 

A– Heroin, morphine, LSD & ecstasy B– Amphetamines (non-injectable) & cannabis C– Benzodiazepines, ketamine

Reclassification of cannabis –  Moved from Class B to C (2004) then back to B in 2008.  Changing classification has impacted on the maximum penalty for possession & supply as a consequence of the changes. Offences under MoD Act 1971 –  Possession of a controlled substance unlawfully.  Possession of a controlled substance with intent to supply (unlawfully).  Trafficking – unlawful supply of a controlled drug o Includes where no charge is made for the drug  Allows premises you occupy/manage to be used for the purpose of smoking cannabis/opium. Maximum penalties under MoD Act 1971 - ** Penalties relating to cannabis –  Possession (adults) o Most offences result in a warning & confiscation of the drug. o If there are aggravating factors (smoking in a public place/repeat offending – arrest & prosecution)  Possession (young people under 18) – o 1st offence – arrest & formal warning/reprimand o Further offences – final warning/charge.

Possession for research purposes –  Small quantities of CDs can be used for research provided they are in nonrecoverable form & not for human consumption.  Home Office Schedule 1 licenses required to possess CDs.  Currently under review – letter from ACMD to Victoria Atkins MP in further reading. Classification under Misuse of Drugs Regulations 2001 – SCH 1 – not used for medicinal purposes SCH 2 – opiates & stimulants

SCH 3 – Barbiturates & minor stimulants SCH 4 – o PART 1 - Benzodiazepines o PART 2 – Anabolic/androgenic steroids & polypeptide hormones SCH 5 – negligible risk / low strength Controls under MoD Regulations 2001 –  Import & export  Possession & supply  Administration  Hospitals & nursing homes  Midwives  Controlled drugs under Patient Group Direction  Patients and their representatives SCH 1    

(CD Lic) – Most strictly controlled group Use limited to research & other special purposes Little / no medicinal use License needed from Home Office to possess, produce & supply (E.G. LSD, weed) Cannabis –  1st November 2018, Home Office amended the MoD Regulations 2001 to move cannabis-based products for medicinal use from SCH 1 →SCH 2  Specialist prescribers now able to prescribe products under the prescribing rules for SCH 2 CDs. o Exception is Sativex, SCH 4 with caveats SCH 2 (CD) –  Full controls relating to – o Prescription requirements o Handwriting requirements o Safe custody  Full records required  Licenses required for import/export  E.G. morphine, fentanyl, diamorphine, oxycodone, amphetamines, CBD products

SCH 3 (CD No Reg) –  Controls not as stringent as for SCH 2 . o Safe custody requirements apply but exemptions exist (phenobarbital, pregabalin, gabapentin & tramadol.  Records required but CD register entry not required.  Invoices must be retained for 2 years.  Licenses required for import/export. o Buprenorphine, gabapentin, pregabalin, tramadol & temazepam. SCH 4 (CD Anab/CD Benz) –  SCH split into 2 parts: o CD Anab – Anabolic steroids & growth hormones o CD Benz – most benzodiazepines (diazepam)  No safe custody, prescription/handwriting requirements/records to be kept.  License needed for import/export.

SCH 5 (CD Inv) –  Low strength preparations of certain controlled substances o Does not include preparations for injection o (morphine sulphate (anamorph) 10mg/5ml Oral solution) o Above 13mg/5ml Morphine remains SCH 2  May be POM / P medicines  Invoices must be retained for 2 years  Negligible risk of abuse (in practice are frequently abused) Prescriptions for CDs –  Prescriptions for SCH 1 to 4 CDs are valid for 28 days from the appropriate date.  Legal requirement to include details of what to prescribe including dosage instructions.  Prescriptions for SCH 2 & 3 CDs must state the quantity in words & figures. Medicinal use of cannabis –  Sativex (Nabiximols)- derived from cannabis & licensed for use in UK for management of multiple sclerosis.  Classified as SCH 4 Part 1 controlled drug but has record requirements of a SCH 2. Application of CD regulations –  Possession  Requisitions  Record keeping  Storage  Destruction

Persons who may possess CDs (P1)–  Holding a Home Office license  Police & Customs Officers  Couriers & Post Office employees  Person engaged in the word of a forensic lab  Public analyst/sampler working under the Food & Drugs Act 1955  Practitioner (doctor/dentist/vet) P2 Registered midwives  Pharmacist/pharmacy owners  Matrons/sisters in charge of a hospital/nursing home/ward  Person in charge of a lab used for scientific education/research  Owner/master of a British ship o Where there is no doctor employed on board P3 –  Master of a foreign ship in GB port  Installation manager of an offshore installation  Person possessing a drug for administration in accordance with the directions of a practitioner (substance misuse patients)  Person licensed under the Wildlife & Countryside Act 1981

Requisition requirements for CDs –  Be signed by the recipient (person authorised for supply)  State name & address, with profession/occupation  Specify total quantity of drug & purpose for which it is required  Supplier must be satisfied that the signature & quantification are genuine Controlled drug register –  Entries must be in ink, in date order & made within 1 day.  Register must be kept at the premises at all times & for 2 years from the last date entry.  Register, documents & stock of drugs must be available for inspection.  Pharmacists must check the ID of people collecting CDs (especially professionals)  Running balance must be kept Controlled drug register ** Storage of CDs –  SCH 1, 2 & some 3 CDs must be stored in a cabinet built to the specification set out in the MoD Regulations 2001.  The pharmacist can obtain police consent to use the pharmacy safe.  SCH 3 required storage are Diethylpropion, Temazepam & Buprenorphine Destruction of CDs –  Stock of SCH 1 & 2 is only permitted in the presence of an appropriate person.  Safe and appropriate disposal is required.  Must comply with disposal of waste regulations & other environmental protection rules...