Storage, recording & disposal of Schedule 2 Controlled Drugs. Dr. Jo Murrell BVSc. (hons), PhD, DiplECVAA, MRCVS

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1 Storage, recording & disposal of Schedule 2 Controlled Drugs Dr. Jo Murrell BVSc. (hons), PhD, DiplECVAA, MRCVS

2 All Controlled Drugs are listed in one of the five Schedules in the Misuse of Drugs Regulations 2001 (MDR) and the Misuse of Drugs Regulations (Northern Ireland) 2002 (MDR (NI))

3 Schedule 2 drugs have therapeutic value but are highly addictive. Their use is strictly controlled with requirements for: special prescription storage record keeping destruction

4 Opioid Drug Schedule Methadone 2 Fentanyl 2 Pethidine 2 Morphine 2 Buprenorphine 3 Butorphanol Not Controlled

5 Legal Requirement Schedule 2 e.g. methadone, fentanyl, pethidine Schedule 3 e.g. buprenorphine Schedule 4 e.g. midazolam, ketamine Safe custody in a Controlled Drugs cabinet The RCVS recommends keeping ketamine in a CDs cabinet Record in a Controlled Drug Register It is good practice to record buprenorphine use The VMD recommends that ketamine use is recorded Witnessed destruction No legal requirement The VMD recommends that destruction of ketamine is witnessed & recorded

6 Storage requirements (Schedule 2&3) It is good practice to keep CDs Kept in a locked container that conforms to British separate Standards to & other is attached medicines to the fabric of the building Clients should not normally have access to the room where CDs are stored Access should be restricted with a key (s) kept by a responsible individual at all times it is not acceptable to have a communal key

7 Record Keeping CD Register must be a bound book or computerized record Within the Register each DRUG, FORM and STRENGTH must have a separate section e.g. separate page for methadone, parenteral fentanyl and transdermal fentanyl solution Entries in the Register must be made in chronological order The Register must be completed within 24 hours Responsibility for correct completion of the Register lies with the prescribing veterinary surgeon

8 Controlled Drugs Register Controlled Drugs received date name & address of supplier amount received (volume ml e.g. Comfortan or no. of vials e.g. buprenorphine 1 ml ampoules) running total (mls or no. of vials)

9 Controlled Drugs Register Controlled Drugs supplied date supplied patient ID e.g. Bruno Smith amount supplied e.g. volume mls or no. of vials amount discarded legible signature of the veterinary surgeon (a counter signature is recommended witness ) running total

10 Dechra CD Register

11 Destruction of Controlled Drugs Out of date CDs cannot be simply disposed of CDs awaiting destruction must be separated from current stock in the CD cabinet & labelled appropriately Who can dispose of OOD CDs? independent veterinary surgeon member of the VMD or RCVS inspection team police officer The majority of practices will easily use a 10 ml bottle of Comfortan with the 28 dds of broaching a vial! no need for disposal of OOD stock

12 Destruction of Controlled Drugs An entry must be made in the Register detailing the items destroyed and the running total of the drug must be updated This must be signed by the authorized witness (e.g. independent veterinary surgeon) CDs must be rendered irretrievable before disposal e.g. by using a commercially available denaturing kit

13 Top 10 tips for recording methadone use in practice 1. Develop a practice SOP for CDs based on the CD legislation & ensure all staff are trained in the SOP!

14 2. Don t let people talk to you while drawing up CDs: concentrate on accurate recording in the Register

15 3. Use a calculator to keep a running total of methadone volume (mls)

16 4. Only have one open bottle of methadone at any one time

17 5. Before drawing up methadone confirm with a visual check that the running total in the Register is correct

18 6. Allow a discard volume of 0.05 ml for each syringe of methadone drawn up

19 7. Square off the running total at the end of each bottle as recommended by the VMD

20 8. Stock check daily (visually) to confirm running total is correct

21 9. Adopt a logical approach to discrepancies in the Register

22 10. Don t view keeping Schedule 2 CDs as a hassle the benefits in terms of analgesia provision outweigh the costs