Prescription Drugs

[citizenB]

Have been regularly collecting my prescription of Tramadol for approximately 3 years - it comes in the bag with the rest of the prescription.

 

Today, I am asked to sign a register that I am taking possession of a controlled substance, Tramadol.

 

When did this come into force ?

[think about it]

Hi CitizenB, it was back in June that it became a controlled drug.

 

http://www.prescriber.org.uk/2014/06/update-to-controlled-drugs-legislation/

 

In the case of Tramadol it seems it was due to it's likelihood of being abused / sold and it's one of a number of drugs that GP's are actively monitored on the amount we prescribe.

[citizenB]

That is very interesting, thank you

[silverfox1961]

I'm on Dihydrocodiene (also known as DF's) and these are also abused yet I don't have to sign anything??

 

I could get 50p per tablet if I didn't need them myself.

[think about it]

It seems that on the basis of it being exempt from the safe custody requirements of other drugs in the same class, a significant part of the shift to controlled status is to act as a deterrent to clinicians for prescribing it where it's not fully clinically indicated. You're right in what you're saying Silverfox, there are many drugs that are liable to abuse that are not on the controlled drugs register and I'd imagine that it's just a matter of time before that scope is expanded to include other commonly misused medication.

 

The one that surprised me particularly was the good old ventolin inhaler, when I worked in a big city GP out of hours provider we had lots of people asking for them as they opened the airways to make the user more receptive to whatever it was they were smoking...

[citizenB]

It seems that on the basis of it being exempt from the safe custody requirements of other drugs in the same class, a significant part of the shift to controlled status is to act as a deterrent to clinicians for prescribing it where it's not fully clinically indicated. You're right in what you're saying Silverfox, there are many drugs that are liable to abuse that are not on the controlled drugs register and I'd imagine that it's just a matter of time before that scope is expanded to include other commonly misused medication.

 

The one that surprised me particularly was the good old ventolin inhaler, when I worked in a big city GP out of hours provider we had lots of people asking for them as they opened the airways to make the user more receptive to whatever it was they were smoking...

 

 

No wonder NHS script charges are increasing at a rate of knots !!

[*RainbowTears*]

It seems that on the basis of it being exempt from the safe custody requirements of other drugs in the same class, a significant part of the shift to controlled status is to act as a deterrent to clinicians for prescribing it where it's not fully clinically indicated. You're right in what you're saying Silverfox, there are many drugs that are liable to abuse that are not on the controlled drugs register and I'd imagine that it's just a matter of time before that scope is expanded to include other commonly misused medication.

 

The one that surprised me particularly was the good old ventolin inhaler, when I worked in a big city GP out of hours provider we had lots of people asking for them as they opened the airways to make the user more receptive to whatever it was they were smoking...

 

Gawd blimey, I had to read that twice to make sure I'd read that right!!

 

Utter disbelief at the fact who thinks up these things......

[think about it]

No wonder NHS script charges are increasing at a rate of knots !!

 

They're free here...

 

The inhaler issue is in part no real joke for the NHS however. Ventolin inhalers are relatively inexpensive and that was back in 2004...

 

One present issue is with genuine users of steroid inhalers, at over £60 each from the supplier (that's with bulk purchasing discounts) we find that people stockpile them. I'm absolutely all for people ensuring that they have one close to hand; perhaps one in a drawer at home, another in your bag / at your desk at work. But we find that people order them every month (who are we to say that they're not using them) only to find that when their condition or medication changes they return half a dozen to us unopened.

 

It's an issue now to the extent where we actively and continually review our asthma/copd patients and discuss their usage with them based on their order patterns. No one is saying that they can't have them, quite the opposite in fact - we want people to use them appropriately as they can make a real difference to those that need them. But please, don't stockpile them, having a spare is fine but you don't need six in your bathroom cabinet. I'm certain that if, like in America, I had to pay 'retail' for our medication I certainly wouldn't have £300 tied up in unused medication.

[citizenB]

They're free here...

 

The inhaler issue is in part no real joke for the NHS however. Ventolin inhalers are relatively inexpensive and that was back in 2004...

 

One present issue is with genuine users of steroid inhalers, at over £60 each from the supplier (that's with bulk purchasing discounts) we find that people stockpile them. I'm absolutely all for people ensuring that they have one close to hand; perhaps one in a drawer at home, another in your bag / at your desk at work. But we find that people order them every month (who are we to say that they're not using them) only to find that when their condition or medication changes they return half a dozen to us unopened.

 

It's an issue now to the extent where we actively and continually review our asthma/copd patients and discuss their usage with them based on their order patterns. No one is saying that they can't have them, quite the opposite in fact - we want people to use them appropriately as they can make a real difference to those that need them. But please, don't stockpile them, having a spare is fine but you don't need six in your bathroom cabinet. I'm certain that if, like in America, I had to pay 'retail' for our medication I certainly wouldn't have £300 tied up in unused medication.

 

 

Wales/Scotland ??

 

I think I read a report a couple of years ago where people had loads of unused drugs in their homes. I know my own Father regularly had his prescription filled for drugs he was no longer taking - so this was definitely a GP/Clinic problem.

 

When we moved him and Mother to their warden assisted flat a couple of years ago - we took 2 carrier bags of - surgical stockings and elasticised bandages (wrong sizes) and 3 of unused /out of date drugs to be disposed of.

 

The Receptionist just took them and shrugged her shoulders !

[silverfox1961]

The bigger problem with drugs is that they don't come in uniform amounts.

 

My painkillers - 100 per box

Other tablets come in either 28 or 30 per pack so over time I build up a supply. At that time, I don't order them so that it brings me back to the right amounts. Just prescribe 28 tablets per pack and be done with it.

 

As for inhalers. Guilty! I ordered every month-just in case- so now I have two spares just sitting in a bag and I have one to hand and one in my coat pocket. I haven't ordered any for the past couple of months.

[BRIGADIER2JCS]

ALL Opioid drugs should be subject to further control now, there is more abuse/ misuse of prescription drugs than ever before.

 

 

A few years ago I was "involved" in a matter concerning the issue of prescription for controlled substances in very large quantities together with large amounts of antibiotics to " fictional" patients, these drugs supplied by the NHA free of charge were then illegally exported to various countries.

[think about it]

The bigger problem with drugs is that they don't come in uniform amounts.

 

My painkillers - 100 per box

Other tablets come in either 28 or 30 per pack so over time I build up a supply. At that time, I don't order them so that it brings me back to the right amounts. Just prescribe 28 tablets per pack and be done with it.

 

As for inhalers. Guilty! I ordered every month-just in case- so now I have two spares just sitting in a bag and I have one to hand and one in my coat pocket. I haven't ordered any for the past couple of months.

 

Completely agree, we occasionally have to re-synchronise people's prescriptions so that they aren't asking for a repeat every week as they progress through the year with uneven amounts in each box. It's a little thing but definitely adds to our workload and proves frustrating for patients.

 

Brigadier, I think that as we're a smaller dispensing practice it's easier to keep a close eye on things however the possibility of issues arising in practices with many more patients, especially those with high numbers of temporary residents such as Uni students must be an additional worry. We're rural and village based so in reality we know most of our patients and they know us, any discrepancy sticks out like a sore thumb and is often noticed before our routine checks pick up on things. Quite how that's done in a practice with 20k patients and a high turnover is another thing. Thankfully EMIS is good at picking up anomalies and we have a fantastic dispensary team who aren't afraid of asking the difficult questions.

[silverfox1961]

Talking about EMIS. I am certain that not many people know about this service.

 

I am registered and order my script online. 3-4 days later, I have it delivered. I need b12 jabs every 3 months and can I remember what date I had it previously. Nope but all I need to do is log on and check my previous orders and it gives the date.

 

Not having to visit the pharmacy to drop of my repeat and then going back 3 days later helps enormously.