Controlled drug

From Ganfyd

Jump to: navigation, search

Contents

International

All jurisdictions regulate psychoactive substances. Such control is for public health reasons but the evidenced based interaction between public health and social control of controlled drug use can be uncomfortable territory for politicians who set drug policy[1]. This can lead to significantly different implications for patients who travel, but are prescribed a controlled drug in one jurisdiction to which different rules apply in another. Doctors who have a right to practice in more than one jurisdiction will also risk falling foul of the relevant law inadvertently. As doctors are more likely to have access to controlled drugs legally the issue of abuse of such by doctors is likely to be covered by specific regulation and sanction.

International context as relevant to UK

In the UK several drugs and classes of drugs are defined by the medicines acts as controlled drugs. The equivalent legislation in the USA is the Controlled Substances Act. Prescriptions and their BNF entries are marked with CD and varyingly greater control is applied to their use, supply and recording than the general run of prescription only medicines (POM). The most controlled are some of the useful opiates and opioids, and various drugs almost entirely of abuse. Controls are exercised - at least in theory - at national and supranational borders on the passage of such drugs, which in the UK are partly dependent on quantity. Currently patients travelling with small quantities of prescribed controlled drugs need a letter from their doctor about it, and with quantities greater than 28 days worth require a form obtainable from the Home Office for import or export.

In some countries certain drugs are simply forbidden, and even the attempt to import them can be potentially lethal and practically will at least leave the patient without presumed urgently required medicine or a patient/doctor detained at that countries convenience. Information on this is available to travellers from embassies and theoretically travel agents. While it is not the responsibility of any doctor not working in a travel clinic to provide relevant advice, it may be possible to be helpful. Further doctors need to be aware of the issues to avoid such situations, which can arise at an international border from just forgetting to remove to safe CD storage an emergency supply of a CD used in clinical practice.

New psychoactive substances

In most jurisdictions there are attempts to pre-classify new substances that may need to be classified by the relevant legislation. This may help deal with the issue common to all jurisdictions that there is a delay in determining a new substances status while that status is assessed formally. In practice this does not work very well.

Jurisdiction examples

60px-Flag of EU.png

Early warning system to aid regulatory authorities

Flag of USA.png

Assumption in law that a substance is a controlled drug until status determined

Flag of New Zealand.png

In New Zealand to supplement the controlled drug list a controlled market in recreational drugs has been created by the psychoactive substances bill 2013. This puts the onus on the drug manufacturer to show that the product pose no more than a low risk of harm before the product is marketed

CD classification schemes

This can be important for a prescriber to understand.

Jurisdiction examples

Flag of the United Kingdom.png

UK Drug Classes: Drugs are classified into Classes A to C, with class A drugs considered to be the most dangerous. Drugs may be moved between categories by statute following recommendation by the Advisory Council on the Misuse of Drugs.

The form required
  • A guide to good practice in the management of CDs in primary care (England) said by the DoH to provide useful good practice guidance on record-keeping is available from background for CD
Flag of USA.png

US Schedule Classification is based on Controlled Substances Act.[2] See US Drug Enforcement Agency web-site for list of drugs.[3][4]

  1. Schedule I
    • The drug or other substance has a high potential for abuse.
    • The drug or other substance has no currently accepted medical use in treatment in the United States.
    • There is a lack of accepted safety for use of the drug or other substance under medical supervision.
  2. Schedule II
    • The drug or other substance has a high potential for abuse.
    • The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
    • Abuse of the drug or other substances may lead to severe psychological or physical dependence.
  3. Schedule III
    • The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II.
    • The drug or other substance has a currently accepted medical use in treatment in the United States.
    • Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.
  4. Schedule IV
    • The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule III.
    • The drug or other substance has a currently accepted medical use in treatment in the United States.
    • Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III."
  5. Schedule V
    • The drug or other substance a low potential for abuse relative to the drugs or other substances in schedule IV.
    • The drug or other substance has a currently accepted medical use in treatment in the United States.
    • Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule IV."

References