Overseeing the safer management of controlled drugs
Sarah Dennison, National Controlled Drugs Manager, Care Quality Commission
CQC are the regulator of health and care services across England and inspect and rate services by focussing on five questions, is the service: safe, effective, caring, responsive, well -led? Arrangements for controlled drugs within a service are assessed along with arrangements for all other medicines as part of CQC’s inspection processes. To support organisations’ controlled drug arrangements, controlled drug self-assessment tools for both primary and secondary care organisations and the newsletters produced by the sub groups are published on the CD pages of the CQC website.
CQC has responsibilities for oversight of the implementation of The Controlled Drugs (Supervision and Management of Use) Regulations 2013 across England. This follows on from the strengthened governance arrangements put in place for controlled drugs following the Shipman enquiry. CQC delivers its national oversight role by maintaining and publishing a register of all CD accountable officers across England, attending NHS England led controlled drug local intelligence networks, chairing a national group and associated sub-groups of regulators and agencies with a controlled drug remit and working collaboratively with cross border colleagues. CQC’s controlled drug’s team report on their findings in an annual update to government and the report is published on the CQC website.
Sarah said this morning: "Cqc annual report ‘safer management of controlled drugs’- cannabis- based medicinal products- hot on news at moment We host a cd national group 3 times a year and a cross boarder group to allow sharing of regulations Challenges for us all to try and keep up with all the different resources PHE - working on addiction on opioids paper The Gosport report due to a culture of blanket prescribing and a disregard for life We want to listen to feedback and learn to improve care With the government practice we need to look at isolated practices Reflections- the report acts both as a warning and a call to action- we have moved on from the Gosport but we also have more guidance’s and governance than ever before’ Cannabis-‘became controlled drugs from 1 nov 2018’ and the news on the Alfie story for the oil as a prescription In nhs we are seeing very little prescribing of cannabis Research and trails need to be carried out more Prescribing trends we covered in the annual report but percentages do not general change But increase in non prescribing with nurses by 10% Pharmacist prescribing increase of 56% We really must challenge and speak up about poor practice"
Reporting and investigating concerns
Julie McCann, Controlled Drugs Accountable Officer, NHS England South Central
The purpose of reporting controlled drug related incidents.
There will be a brief overview of the legislation and guidance for incident reporting and managing concerns for both commissioning and provider bodies followed by an outline of the process taken by NHS England at a regional and national level.
The types of incidents received by NHS England will be considered and how incidents are assessed to decide if further investigation is required. This will take into account the nature of the incident, what actions have been taken, lessons learnt and how these lessons have been shared.
There will be an explanation of how the NHS England controlled drug reporting tool is used to manage incidents locally and how it facilitates the identification of trends and lessons learnt locally and nationally.
Full PowerPoint Presentation
New controls for pregabalin and gabapentin
Dr Sarah Rann, Controlled Drugs Accountable Officer, NHS England Midlands and East
Gabapentinoids are used to treat epilepsy, neuropathic pain and, in the case of pregabalin, anxiety. They have come to be used for a wider range of indications than is supported by the evidence or their licensing, and they have sometimes been prescribed in place of opioids or benzodiazepines in the likely- mistaken belief that they are less liable to misuse or dependence, and lack of awareness of the withdrawal problems that can arise when prescribing is stopped.
The latest update of the Cochrane review of 37 studies on 5,914 participants with a typical duration of treatment of 4 to 12 weeks has only moderate quality evidence (mainly due to small sample size).89 The review concludes that gabapentin is effective for shingles-related pain: 32% with substantial benefit (at least 50% pain intensity reduction or pain rated as very much improved) versus 17% for placebo. On the same outcome measure for diabetic neuropathy the findings were 38% versus 21%. Some patients with these problems may experience drug-related adverse events and some who tolerate the drug will not derive clinically meaningful benefit
Gabapentinoids prescribing has seen a rise that continues the trends seen in previous years, from under a million prescriptions in 2008 to 7 million in 2018. They are also prescribed for longer. The number of patients who received a prescription for gabapentinoids continuously between April 2015 (and perhaps earlier) and March 2018 was 160,000 . Prescribing rates gabapentinoids have a strong association with deprivation .
Gabapentinoids are associated with a risk of dependence and withdrawal. Gabapentinoids can cause reinforcing subjective effects, including euphoria, sedation and dissociation, and may be sought as a recreational drug
The combination of gabapentinoids, opioids and benzodiazepines and z-drugs, can all increase respiratory depression, leading to overdose and possible death. There is evidence of increased mortality of patients on gabapentin and pregabalin who are co prescribed opioids. There is evidence of drug interactions between pregabalin and opioids
Dependence on gabapentin and pregabalin is estimated to be about 1.6% in the general community but much higher in certain groups. It is estimated that 3 - 68% of opioid misusers also misuse pregabalin/gabapentin. Patients with mental health/substance misuse issues are also particularly at risk of dependence on gabapentin/pregabalin.
Full PowerPoint Presentation