Substance Use and Misuse
Misuse of Drugs Act 1971 – controls possession, supply, manufacture, import and export of
CDs except as allowed by regulations or by license from the Secretary of State
Class A Class B Class C
Cocaine Amphetamine
Ecstasy Barbiturates Anabolic steroids
Heroin Cannabis Benzodiazepines
LSD Codeine GBL
Magic mushrooms Ketamine GHB
Methadone Mephedrone Khat
Methamphetamine Methylphenidate
Possession = 7 years + fine Possession = 5 years + fine Possession = 2 years + fine
Supply = lifetime + fine Supply = 14 years + fine Supply = 14 years + fine
Misuse of Drugs Act 1971 – covers prescribing, administering, safe custody, dispensing,
record keeping, destruction and disposal of CDs to prevent diversion for misuse
Controlled Drugs (Supervision of Management and Use) Regulations 2013 – covers the safe
management of use of CDs and accountable officers
Schedule 1 Schedule 2 Schedule 3 Schedule 4 Schedule 5
Clenbuterol
Amphetamine
Diazepam
Diamorphine Buprenorphine
Human chorionic
Lis- Diethylpropion
Cannabis gonadotrophin Codeine
dexamfetamine Midazolam
Mescaline Lorazepam Pholcodine
Morphine Temazepam
Zaleplon
Pethidine Tramadol
Zolpidem
Secobarbital
Zopiclone
Group 1 (ketamine, cannabis, diamorphine, cocaine, LSD, methylamphetamine) – this is a
zero tolerance group but given the low limits sets, a Pt prescribed one of these could test
above the limit but would still be entitled to raise ‘medical defence’
Group 2 (temazepam, morphine, diazepam, amphetamine, methadone, clonazepam) – the
higher limits in this group are generally above the normal therapeutic range hence most Pts
are unlikely to be driving ‘over the specified limit’. Pts are entitled to ‘medical defence’
Emergency supplies of Schedule 2 or 3 CDs (except phenobarbitone for epilepsy) are never
allowed. Doses should never be given in advance of receipt of a valid Rx. Phoned or faxed
prescriptions are also illegal.
, Supervised Administration (NHS Enhanced Service commissioned locally)
Aims of supervised administration:
1. To ensure compliance with an agreed Tx plan by dispensing in specified instalments and
ensuring each supervised dose is correctly consumed
2. To reduce risk to local communities of over usage or under usage of meds, diversion of
Rx drugs onto the illicit drugs’ market and accidental exposure
3. To provide Pts with regular contact with HCPs
An instalment direction of Schedule 2 or 3 CDs combines two pieces of info – amount of
medicine per instalment and the interval between each time the med can be supplied
Instalment Rx must have both a dose and an instalment amount specified separately
The 1st instalment must be dispensed within 28 days of the appropriate date. The
remainder should be dispensed according to the instructions (even if this runs beyond
28 days after the appropriate date). If the only date on the Rx is the date of signing, the
1st dispensing needs to occur within 28 days of this date.
If prescriber indicates a date before which the Rx must not be dispensed, this would be
the appropriate date instead. The Rx must then be marked with the date of each supply.
Many Rx have the interval written in as dates of dispensing. Rxs ordering ‘repeats’ on the
same form are not allowed.
A maximum of 14 days’ Tx may be prescribed on a FP10MDA in England. Only the
following can be supplied in instalments on this form – schedule 2 CDs, buprenorphine,
diazepam and buprenorphine/naloxone
If the Rx is incorrect in any way, you can refuse to dispense it which is why receiving the
Rx in advance is useful. The prescriber can be contacted and the Rx can be amended.
Approved wording for missed dose – supervised consumption:
‘If an instalment’s collection day has been missed, please still dispense the amount due for
any remaining day(s) of that instalment’
‘Consult the prescriber if three or more consecutive days of a Rx have been missed’
Approved wording for when the pharmacy is closed:
‘Please dispense instalments due on pharmacy closed days on a prior suitable day’
Other approved wording:
‘For supervision: supervise consumption on collection days’
‘Containers: dispense daily doses in separate containers
Rx must comply fully with requirements for Schedule 2 and 3 CDs as in the MEP
Rx must comply fully with the instalment prescribing guidelines for it to be dispensed for
the Pt. If not, supply can be refused, and prescriber should be contacted
Rx must clearly specify that supervision is required. However, supervision is a direction
NOT a legal requirement. It should be adhered to but there may instances where a Pt
cannot collect their meds themselves and sends a representative. The pharmacist may
