The Shipman inquiry concluded that there were several shortcomings in the management system for controlled drugs (http://www.the‐shipman‐inquiry.org.uk/home.asp). As a result, changes to prescribing and dispensing of controlled drugs are being introduced.
We are concerned that the implications, and possibly unintended consequences, of the new guidance have not been widely recognised or publicised to paediatricians and child psychiatrists.
We first became aware of changes to prescribing policy after several phone calls from local pharmacists refusing to issue more than 28 days supply of methylphenidate for our patients with attention deficit hyperactivity disorder, and so we sought further clarification.
Changes will be introduced, subject to parliamentary approval, in the summer of 2006. In some cases the changes will be effected through professional guidance, and in other cases through further amendment to the Misuse of Drugs Act Regulations (http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID = 4131465&chk = qsfbI9). The key issues affecting paediatricians are the following:
Duration of any prescription for schedule 2 (eg, methylphenidate 2, which is a controlled drug), 3 and 4 controlled drugs should be restricted to 28 days.
Introduction of 28‐day maximum quantity on prescriptions for schedule 2, 3 and 4 controlled drugs.
In future, prescriptions should be printed rather than hand written.
Re‐emphasis of professional guidance that doctors should prescribe controlled drugs for themselves or family members only in exceptional circumstances.
Clearly, it will have a huge effect on the paediatric prescribing workload if we had to issue monthly repeat prescriptions for all children on methylphenidate. Further discussion with The Department of Health showed that in exceptional circumstances where the prescriber believes that it is clinically indicated and would not pose an unacceptable risk to patient safety, a prescription for >28 days, may be allowed. It was suggested that the trust “Prescribing Lead” highlight the issue of methylphenidate with local pharmacies and that the issue of methylphenidate be specifically considered in the future.
In the short term, paediatricians need to be ready to justify their prescribing decisions and need to be aware that prescriptions for >28 days' supply may not be dispensed; they may then wish to invest in a departmental prescription printer!
Footnotes
Competing interests: None declared.