Management of Narcotic

Drugs

Prepared By : Reviewed By :
• Harmanjeet Kaur Gill Dr. Lallu Joseph
• Khushboo Masih
Dr. Swati Makeshir
• Dr.Mini Phogat
• Dr.Deepika Sharma Dr. Shweta Prabakar
 What are Narcotics?
Narcotics are a class of drugs that produces

• Analgesia (pain relief)

• Narcosis (state of stupor or sleep)
• Addiction (physical dependence on
the drug)

In some people narcotics also produce

euphoria (a feeling of great elation)
 Description of Laws governing Narcotics

• The Drugs & Cosmetics Act 1940

• The Narcotic and Psychotropic
Substance Act 1985
• Strict adherence to instructions
issued by the State Government
Authorities
Definition of Categories
Controlled • A controlled (scheduled) drug is one whose use
and distribution is tightly controlled because of
(Scheduled) its abuse potential or risk. Narcotic Drugs and
Psychotropic Substances Act (NDPS) 1985 limits
Drug the use of these agents for medicinal purposes.

• Narcotic drugs include all dosage forms of

Narcotic opioid derivatives such as Morphine,
Pethidine, Fentanyl and Sufentanil which
Drugs require a license from the regulatory authority.

• Psychotropic drugs (e.g. other opioid

Psychotropic derivatives like Pentazocine, Tramadol;
Benzodiazepine group like Midazolam,
Drugs Diazepam, Alprazolam etc.)
Process - Obtaining License

License pre requisites to be fulfilled

(e.g. Hospital Pharmacy License
Form 20 & 21)

Application of narcotics license to be

made by the Admin Head to the
appropriate authority once Pharmacy
license is received. Acknowledgement
to be maintained in unit records.

Application status to be followed

up by unit and status update to be
communicated to FD regularly.
 Recognition of Medical Institutions
is as per Narcotic Drugs and Psychotropic
Substances (Third Amendment) Rules 2016

Apply
Form No. 3F to the Controller of Drugs

Action
Issued By the Controller of Drugs for a
Form No. 3G
period not exceeding 3 years within 60 days

Renewal
at least 60 days before expiry of prior
to the Controller of Drugs
permission
Designated Medical Practitioner
• Every recognized medical institution shall designate one or
more registered medical practitioner who has undergone
training in pain relief and palliative care for prescription of
essential narcotic drugs for pain relief and palliative care or
training in opioid substitution therapy for prescription of
essential narcotic drugs for treatment of opioid dependence,
who shall prescribe and dispense essential narcotic drugs.

• b. When more than one registered medical practitioner is

designated, one of them shall be designated as over-all in
charge.

• The name of the designated medical practitioner or the over-

all in charge, as the case may be, shall be endorsed on the
Certificate of Recognition by the Controller of Drugs.
• Any change in the DMP to be notified within 7 days for
endorsement.
Estimation of Requirement
• by 30th November every year, the Recognized
Medical Institute shall submit an estimate of its
annual requirement of Narcotics for the next year.
• If the requirement of a Recognized Medical
Institution exceeds (or is likely to exceed) the
annual estimate submitted to the Controller of
Drugs, it shall submit a revised estimate by
the 31st August

The procurement is handled by the Pharmacy in

accordance with various rules including those of
the Excise Department.
Storage & Documentation
• All Narcotic drugs will be stored/ kept in lock
cupboards .
• Strict accounting of Narcotic Drugs shall be
maintained. All entries in the records should
be clear & legible & there should be no overwriting or
use of whitener. In case of a
wrong entry, it should be struck off with a single line
and be counter signed.
• Proper environmental control should be there.
• A designated Pharmacist shall do daily physical stock
verification and a strict ledger to be maintained.
• Strict Daily accounting of all Narcotic drugs will be
observed in the Pharmacy by the Registered Medical
Institution in Form 3H in addition to the above
mentioned Stock Register/ Ledger.
Secondary Locations
• A limited stock can be loaned from the
pharmacy and documented strictly.
• Once the stock is approved, a laminated
copy of this form is to be
displayed on the inside of the Narcotics
cupboard.
• The Charge nurse / Nursing Supervisor /
OT In-charge / Technician of respective
patient care area shall be responsible for
strict daily accounting.
Indenting, Dispensing & Administration of Narcotic
Drugs

• For OPD patient’s Form 112 is to be used.

• In IPD for indenting & maintaining strict accounting of
Narcotic drugs, ‘Patient Narcotics Sheet’ (self-carbon
triplicate sheets in book form), will be maintained in each
Patient Area (in both Secondary & Non Secondary
Locations) where Narcotics are prescribed and used.

• The ‘Patient Narcotics Sheet’ is a detailed sheet which

has 4 sections & includes:
• Form 3E (Details of the Patient to whom essential
Narcotic Drug Dispensed)
• Prescription for Narcotics
• Administration cum Indent Form and
• Return Slip
Indenting & Dispensing of Narcotic Drugs

• For Narcotics to be prescribed for a patient, a fresh

‘Patient Narcotics Sheet’ (self-carbon triplicate sheets in
book form), annexed as shall be initiated by Nurse every
day in the patient area by recording the Patient’s IPID
Number in the Registration Section of the Form 3E.
• Buffer stock shall be maintained in secondary locations
for immediate use by the nurse in charge and the records
shall be maintained by the nurse in charge.
• The replacement has to be ordered in the name of the
patient to whom the Narcotic has been dispensed by
filling the relevant sheet Form 3E.
• The Nurse shall then record the Date, the Patient’s Name
and Complete Postal Address with contact details OR
IPID/UHID of the patient in the Form 3E section.
• The Doctor shall record the Brief description of the
illness.
• The Doctor shall fill the details regarding the Narcotic
Drugs Prescribed {Dosage Form, Drug Name, Dose,
Frequency, Route of Administration, & period of
consumption (One Day) of the prescribed Narcotic}, in
the Prescription section of the form. Multiple drugs may
be prescribed on the same Prescription

• The Doctor shall then put his/her Signature, Full Name &
Registration Number.

• The Nurse shall, from the above prescription, record the

Dosage Form, Drug Name, Dose prescribed, & the Route
of Administration or each single dose (i.e. for each
Injection/Tab/Patch), in separate rows in the Indent cum
Administration section.
Counter Check of Patient Narcotic Book & Narcotic
Drug Daily Count Register
The Patient Narcotic Sheets in The Patient
Narcotic Book shall be checked on each
working day for completion, by the
Morning Duty Nursing Supervisor (may
be done by OT Manager for OT), who
shall accord his/her signature after
checking
Disposal/Return of Narcotic Drugs

– Small quantity if left over after

administration of drug will be disposed
off in flowing water (preferably in hopper
going into ETP/STP) in the presence of
another Nurse/person and the same shall
be documented in the ‘Patient Narcotics
Book’ (Book containing serially
numbered self-carbon triplicate sheets),
annexed as
Audits
• Audits
• Pharmacy will perform an audit of
Secondary Locations at least once a
month (ANNEXURE-13) to ensure
compliance with proper storage and
inventory management of Narcotic drugs
• Units shall undertake monthly self-
assessment to ensure compliance with this
policy
Thank You