Storage, recording & disposal of Schedule 2 Controlled Drugs

Dr. Jo Murrell

BVSc. (hons), PhD, DiplECVAA, MRCVS

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))

• Schedule 2 drugs have therapeutic value but are highly addictive. Their use is strictly controlled with requirements for:

– special prescription

– storage

– record keeping

– destruction

Opioid Drug Schedule

Methadone 2

Fentanyl 2

Pethidine 2

Morphine 2

Buprenorphine 3

Butorphanol Not Controlled

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

Storage requirements (Schedule 2&3)

• Kept in a locked container that conforms to British Standards & is attached 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

It is good practice to keep CDs separate to other medicines

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

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)

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

Dechra CD Register

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

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

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!

2. Don’t let people talk to you while drawing up CDs: concentrate on accurate recording in the Register

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

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

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

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

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

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

9. Adopt a logical approach to discrepancies in the Register

10. Don’t view keeping Schedule 2 CDs as a “hassle” the benefits in terms of analgesia provision outweigh the “costs”