In the United Kingdom, controlled drugs are those preparations referred to under the Misuse of Drugs Act 1971. The Act prohibits activities related to the manufacture, supply and possession of these drugs, and they are classiﬁed into three groups which determine the penalties for oﬀences involving their misuse. For example, class A includes COCAINE, DIAMORPHINE, MORPHINE, LSD (see LYSERGIC ACID DIETHYLAMIDE and PETHIDINE HYDROCHLORIDE. Class B includes AMPHETAMINES, BARBITURATES and CODEINE. Class C includes drugs related to amphetamines such as diethylpropion and chlorphentermine, meprobamate and most BENZODIAZEPINES and CANNABIS.
The Misuse of Drugs Regulations 1985 deﬁne the classes of person authorised to supply and possess controlled drugs, and lay down the conditions under which these activities may be carried out. In the Regulations, drugs are divided into ﬁve schedules specifying the requirements for supply, possession, prescribing and record-keeping. Schedule I contains drugs which are not used as medicines. Schedules II and III contain drugs which are subject to the prescription requirements of the Act (see below). They are distinguished in the British National Formulary (BNF) by the symbol CD and they include morphine, diamorphine (heroin), other opioid analgesics, barbiturates, amphetamines, cocaine and diethylpropion. Schedules IV and V contain drugs such as the benzodiazepines which are subject to minimal control. A full list of the drugs in each schedule can be found in the BNF.
Prescriptions for drugs in schedules II and III must be signed and dated by the prescriber, who must give his or her address. The prescription must be in the prescriber’s own handwriting and provide the name and address of the patient and the total quantity of the preparation in both words and ﬁgures. The pharmacist is not allowed to dispense a controlled drug unless all the information required by law is given on the prescription.
Until 1997 the Misuse of Drugs (Notiﬁcation and Supply of Addicts) Regulations 1973 governed the notiﬁcation of addicts. This was required in respect of the following commonly used drugs: cocaine, dextromoramide, diamorphine, dipipanone, hydrocodeine, hydromorphone, levorphanol, methadone, morphine, opium, oxycodone, pethidine, phenazocine and piritranide.
In 1997 the Misuse of Drugs (Supply to Addicts) Regulations 1997 revoked the 1973 requirement for notiﬁcation. Doctors are now expected to report (on a standard form) cases of drug misuse to their local Drug Misuse Database (DMD). Notiﬁcation by the doctor should be made when a patient ﬁrst presents with a drug problem or when he or she visits again after a gap of six months or more. All types of misuse should be reported: this includes opioids, benzodiazepines and central nervous system stimulants. The data in the DMD are anonymised, which means that doctors cannot check on possible multiple prescribing for drug addicts.
The 1997 Regulations restrict the prescribing of diamorphine (heroin), Diconal® (a morphine-based drug) or cocaine to medical practitioners holding a special licence issued by the Home Secretary.
Fuller details about the prescription of controlled drugs are in the British National Formulary, updated twice a year, and available on the Internet (see www.bnf.org).