New NICE guidance urges safer use of controlled drugs

NICE has published guidance to support the safe use and management of controlled drugs.

Unsafe use of controlled drugs is the major cause of serious harm from medication incidents reported to the National Reporting and Learning System. | SCIENCE PHOTO LIBRARY
Unsafe use of controlled drugs is the major cause of serious harm from medication incidents reported to the National Reporting and Learning System. | SCIENCE PHOTO LIBRARY

The newly issued guidance from NICE reminds prescribers that prescriptions for controlled drugs should only provide enough medication to last a patient 30 days. In exceptional circumstances where more than 30 days’ supply is required, the reason for this should be noted in the patient's record. If a controlled drug is being prescribed for use ‘as required’, any existing supplies the patient may have should be taken into account.

Further information
NICE guidance
Opioid equivalence table
Guidance on initiating transdermal opioids

When prescribing controlled drugs, GPs should consider the benefits and risks of treatment and take into account other medications the patient may be taking – as well as whether they are opioid-naive. A recognised opioid dose conversion guide should be used to calculate the total opioid load when prescribing, reviewing or changing opioid prescriptions.

Notes should be made in the patient's record detailing the indication and regimen for the controlled drug, instructions for when and how to take ‘as required’ drugs and, if local or national prescribing guidance has not been followed, the reasons for this. Clear instructions must be also included on the prescription when controlled drugs are prescribed for use ‘as required’.

The section on prescribing controlled drugs also covers advice that should be given to patients, their carers and family members. For example, when more than one formulation is prescribed, the differences between these should be explained and prescribers should check that patients and carers understand what each formulation is for. 

Non-prescribing healthcare professionals may also find the guidance useful as it covers record-keeping, requirements for stock counts, administration, destruction and transportation of controlled drugs.

Fatal incidents

Dr Tessa Lewis, GP and chair of the guideline development group, said "Our aim with this guideline is to support organisations and individuals to minimise the potential harms associated with these medicines by having robust systems and processes in place for their use."

A 7-year review of medication safety incidents reported to the National Reporting and Learning System found that the risk of death in incidents involving controlled drugs was significantly greater than with medication incidents generally (odds ratio 1.484, 95% CI 1.015–2.169). The five most commonly used controlled drugs – morphine, diamorphine, fentanyl, midazolam and oxycodone – were responsible for 88% of incidents that resulted in death or severe harm.

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