The misusing of drugs in pharmacy. pptx

Misuse of drugs
Dr: Alaa Balla Suliman
(4)

Introduction and general terms:
• The term ‘controlled drug’ is commonly used
to deﬁne drugs that have the potential to be
misused or abused.
• The term actually refers to the controls placed
on the possession, sale, supply and
administration of the medicine, and not the
nature of use associated with the drug.

• Drug use: refer to consumptions of
psychoactive substances without medicals or
healthcare instructions.
• Drug misuse(abuse): drug use that
problematical and cause significant risk and
harm.
• Dependence or addiction: compulsion to
continue administrations of psychoactive
substances in order to avoid physical or
psychological withdrawal effects.

• Drug dependence WHO definition: a cluster of
psychological , behavioral and cognitive
phenomena of variable intensity in which the
use of psychoactive drug takes on a high
priority. The necessary descriptive
characteristics are preoccupation with a desire
to obtain and take the drug and persistent
drug seeking behavior.

• Withdrawal: when person stop using a
substance they are dependent on. two forms:
1. Physical withdrawal effects eg. Seizers,
palpitation and anxiety.
2. Psychological effects eg. intense craving,
altered mood and depression.

• Amongst the public generally there is a high level
of social anxiety surrounding the use of these
types of drug and a potential stigma with regard
to patients using this class of medication.
• Many effective medicines, classiﬁed as controlled
drugs, have a legitimate use as licensed medicines
for the treatment of illness.
• However some have a potential for misuse
because they are physically or psychologically
addictive, they may have hallucinogenic
properties or they enhance sporting performance.

Some common psychoactive drugs:
Effect on CNS Method of adm. Drug
Hallucinogenic Orally Lysergic acid diethylamine
Depressant Orally in drinks Ethanol
Stimulation Orally Caffeine
Depressant smocked Cannabis(hashish or
marijuana)
Stimulation and
hallucinogenic
Orally as tablet Methamfetamine
Depressant Inhalation or IV Heroin, diamorphine
Stimulation Nasally or IV Amfetamine
Stimulation Smoking or chewing Nicotine
stimulation Nasal, orally or IV cocaine

History:
• despite their medical beneﬁts, these types of
drugs have a propensity for overuse and abuse.
As a result legislation has been introduced at
various times in the past to try to limit and
control the dangers they pose. The most recent
of these is the Misuse of Drugs Act 1971.
• Before 1868 there were no restrictions on who
could supply medicines and drugs. Many
popular medicinal products available in the
19th century contained opium or its derivatives.

• In 1920 the first Dangerous Drugs Act was passed.
This prohibited the import or export of products in
the newly defined class of dangerous drugs without
a license and more importantly it created a criminal
offence out of breaches of the act. The Act resulted
in opium, cocaine, morphine and diamorphine being
classified as ‘dangerous drugs’.
• It also established powers of inspection not just of
pharmacies but also the premises of manufacturers,
wholesalers and distributors of dangerous drugs.

• Regulations made under the Act deﬁne and control legal
possession and supply for medicinal use and licenses are
issued to allow legal manufacture and trade in controlled
drugs. Unless following the regulations or holding a license
it is illegal to possess ,manufacture ,trade , supply or use
controlled drugs.
• the Misuse of Drugs Regulations 2001, the main change
being to introduce changes to the way benzodiazepine
drugs were regulated.
• The Misuse of Drugs Regulations 2001 (as
amended)stipulate how controlled drugs may be prescribed
on prescription, how they are handled and stored in
pharmacies and how they are supplied to patients.

schedules to the Misuse of Drugs Regulations
2001:
• schedule 1 being subject to the most stringent controls and
schedule 5 having the least restrictive controls.
1. Schedule1 includes drugs with no medicinal uses.
cannabinoid-based products as a result of having taken part
in a clinical trial.
2. Schedule2 controlled drugs( CD POM) include the medicinal
opioids (e.g. morphine and diamorphine), medicinal
stimulants and the more potent barbiturates that are
associated with a greater likelihood of dependence. Drugs
within this schedule have the highest level of restrictions for
manufacture, possession and supply. Pharmacists are legally
authorized to manufacture and supply schedule 2 controlled
drugs.

3. Schedule 3 includes the controlled drugs that
are considered to be less likely to be misused
than those drugs in schedule 2 The
requirements for supply of schedule3 controlled
drugs are similar to those in schedule 2 but are
not quite so restrictive: one of the main
differences is that there is no need for register
entries to be made. The most commonly used
schedule 3 drugs in community pharmacy are
temazepam, phenobarbital, buprenorphine and
Midazolam.

4. Schedule 4 is divided into two sections: part 1
contains the benzodiazepines, for example
diazepam and nitrazepam, and part 2 covers
anabolic steroids for medicinal use.
5. Schedule 5 includes products that contain
controlled drugs from schedule 2 as an ingredient
but at a much reduced strength. The most
commonly used examples are morphine oral
solution, kaolin and morphine mixture, codeine
linctus and pholcodeine linctus. Many schedule 5
drugs can be purchased over the counter in
pharmacies.

Information concerning misuse:
• Doctors, pharmacists and persons lawfully
conducting retail pharmacy businesses in any
area may be called upon to give particulars of
the quantities of any dangerous or otherwise
harmful drugs (not necessarily controlled
under the Act) which have been prescribed,
administered or supplied over a particular
period of time.

Provisions for preventing misuse (in the
pharmacy):
1. require precautions to be taken for the safe
custody of Controlled Drugs.
• The safe custody requirements mean that
pharmacists must keep controlled drugs in a locked
cabinet when not currently in use–when they are
not actually in the process of being dispensed.
Access to controlled drugs must be restricted to
the pharmacist or to members of staff authorized
by the pharmacist, as set out in the standard
operating procedures for the pharmacy.

2. impose requirements as to the
documentation of transactions involving
Controlled Drugs, and require copies of
documents relating to such transactions to be
furnished to the prescribed authority.
3. require the keeping of records and the
furnishing of information with respect to
Controlled Drugs and in such circumstances and
in such manner as may be prescribed.

4. provide for the inspection of any precautions taken or
records kept in pursuance of regulations under this section.
5. relate to the packaging and labeling of Controlled Drugs.
6. regulate the transport of Controlled Drugs and the
methods used for destroying or otherwise disposing of
such drugs when no longer required.
7. regulate the issue of prescriptions containing Controlled
Drugs and the supply of Controlled Drugs on prescriptions,
and require persons issuing or dispensing prescriptions
containing such drugs to furnish to the prescribed
authority such information relating to those prescriptions
as may be prescribed.

8. require any doctor who attends a person who
considers or has reasonable grounds to suspect, is
addicted (within the meaning of the regulations)
to Controlled Drugs of any description to furnish
to the prescribed authority such particulars with
respect to that person as may be prescribed.
9. prohibit any doctor from administering,
supplying and authorizing the administration and
supply to persons so addicted, and from
prescribing for such persons such Controlled
Drugs as may be prescribed.

Prescriptions for Controlled Drugs:
• Prescription means a prescription used by a
doctor for the medical treatment of a single
individual.
• No prescription requirements are laid down
for any Controlled Drug in Schedules 4 or 5 to
the regulations except for temazepam.

• a prescription must not be issued unless it complies with the
following requirements:
1. be written so as to be indelible, be dated and be signed by the
person issuing it with usual signature and dated by (it is
unlikely that a carbon copy, even one bearing an original
signature would be sufficient to satisfy the indelibility
requirement).
2. except in the case of a health prescription, it must specify the
address of the person issuing it.
3. it must have written there on, if issued by a dentist, the words
‘for dental treatment only’ and, if issued by a veterinary
surgeon or a veterinary practitioner, a declaration that the
Controlled Drug prescribed is for an animal under care.

4. it must specify the name and address of the person
for whose treatment it is issued or, if it is issued by a
veterinary surgeon or veterinary practitioner, the name
and address of the person to whom the Controlled Drug
prescribed is to be delivered.
5. it must specify the dose to be taken, and a in the case
of a prescription containing a Controlled Drug which is a
preparation, it must specify the form and, where
appropriate, the strength of the preparation, and either
the total quantity (in both words and figures) of the
preparation or the number (in both words and figures)
of dosage units, as appropriate, to be supplied.

6. in the case of a prescription for a total
quantity intended to be dispensed by
installments, it must contain a direction
specifying the amount of the installment so the
total amount which must be dispensed and the
intervals to be observed when dispensing.

The management of drug use and dependence:
A range of strategies is used to prevent , limit the
extent of and address the problems associated with
drug use and dependence:
1. Primary prevention: health promotion and
education campaign, legislation.
2. Secondary prevention: discouraging farther use.
3. Drug education: leaflet, book ,videos and posters.
4. Social support.

5. Detoxification: provision of treatment to help
someone to stop drug using; use of diazepam at
gradually reducing dose in benzodiazepine
dependence.
6. Rehabitation: provided within a therapeutic
community participant live in the environment
where treatment is given(several months)
7. Harm reduction: prevent sharing of injecting
equipment.

The misusing of drugs in pharmacy. pptx

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