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Drugs and the law
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
Section 5 of the MDA makes it an offence to possess a Controlled Drug. However, under Regulation 10(1) of the Misuse of Drugs Regulations a practitioner or pharmacist may possess and supply a drug contained in Schedules 2–4. It is this regulation which gives authority to doctors to have a Controlled Drug in their possession and to administer it according to their clinical judgement. However, a specific licence is required before practitioners can prescribe cocaine, diamorphine or dipipanone to treat a dependency on those drugs, although any doctor can prescribe those drugs for other purposes. Any doctor may prescribe methadone for an opiate user.
Narcotic Analgesics And Antagonists
Published in S.J. Mulé, Henry Brill, Chemical and Biological Aspects of Drug Dependence, 2019
Only one narcotic analgesic methadone derivative, out of the several hundred known, has achieved some slight clinical utility, dipipanone (4, 4-diphenyl-6-piperidino-3-heptanone, see Formula 25). In dipipanone the nitrogen atom has been tied into a piperidine ring. The drug is not available in the United States, but is utilized in Britain.4 It displays a more rapid onset and shorter duration of action than methadone, and is useful for treating moderate pain at a 25mg dose level with minimal side effects; higher doses increase the side effects disproportionately.38 Dipipanone, of course, has dependence liability.
Pharmacological interventions
Published in Grahame Smith, Dementia Care, 2018
It is easy to become confused by the types of non-medical prescribing in existence. The medicinal products:Prescription by Nurses Act (1992) is legislation within the Medicines Act that permitted nurses to prescribe for the first time. This act allowed district nurses and health visitors who had successfully completed a recommended programme to become registered with the NMC as prescribers. These prescribers could prescribe from the Nurse Prescribers Formulary.V100: This is community practitioner prescribing that allows nurse practitioners who have completed the appropriate qualifications that allow access to prescribe from that specific formulary only.V150: Noncommunity nurse practitioners who are appropriately qualified and recorded on the NMC register are allowed to access the community practitioner formulary only.V300: This is in regard to independent and supplementary prescribers—nurses who have appropriate qualifications and record on the NMC register with access to prescribe any medicine for any medical condition. Nurse independent prescribers are able to prescribe, administer, and give directions for the administration of Schedule 2, 3, 4, and 5 controlled drugs. This extends to diamorphine, dipipanone, or cocaine for treating disease or injury, but not for treating addiction (British National Formulary [BNF], 68).Supplementary prescribing: This is ‘a voluntary partnership between an independent prescriber (doctor or dentist) and a supplementary prescriber (nurse, pharmacist or Allied Health Professional) to implement an agreed patient specific clinical management plan with the patient’s agreement’ (DH, 2003).
The impact of the COVID-19 pandemic lockdown measures on the prescribing trends and utilization of opioids in the English primary care setting: segmented-liner regression analysis
Published in Expert Review of Clinical Pharmacology, 2022
Oula Nawaf Sindi, Faisal Salman Alshaikh, Brian Godman, Amanj Kurdi
This analysis was based on a retrospective, cross-sectional study of the opioids dispensed in the primary care setting in England using Prescription Cost Analysis (PCA) data, an aggregated, publicly available dataset. PCA datasets contain information about all prescribed medicines issued by GPs in the community in the UK, which includes medication’s name, quantity, strength, and formulation [12]. Opioid utilization was measured 12 months pre (March 2019–February 2020) and 12 months post the first national COVID-19 lockdown (April 2020–March 2021) including March 2020 when lockdown measures were enforced, equating to a total study duration of 25 months. This study included all of the opioid prescriptions that are indicated for pain management stratified into strong opioids (morphine, hydrophone, fentanyl, oxycodone, diamorphine, tramadol, tapentadol, methadone, buprenorphine, dipipanone, pentazocine, and pethidine) and weak opioids (codeine, dihydrocodeine, and meptazinol) based on the British National Formulary (BNF) classification [13]. Some methadone and buprenorphine preparations that are included in section 4.10 of the BNF are mostly used for opioids substitution therapy/opioid dependence [13]. Consequently, they were excluded as these preparations are unlikely to be prescribed for pain relief in the UK [14]. The study did not require ethical approval as we used publicly available datasets.