A controlled substance is a drug or chemical whose production, possession, and usage are all regulated by the government, such as illegal drugs or legally prescribed medications.
In the United Kingdom, drugs are classified in a variety of ways. A controlled substance is a substance that falls into one of these categories, and it may be illegal to possess or consume. Some may be legal to use if prescribed by an authorised entity.
The MDA is the most significant law controlling the treatment of illicit drugs.
It divides various substances into three categories:
Class A includes alfentanil, cocaine, diamorphine hydrochloride (heroin), dipipanone hydrochloride, fentanyl, lysergide (LSD), methadone hydrochloride, 3, 4-methylenedioxy-methamphetamine (MDMA, ‘ecstasy’), morphine, opium, oxycodone hydrochloride, pethidine hydrochloride, phencyclidine, remifentanil, and class B substances when prepared for injection.
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Class B includes oral amfetamines, barbiturates, cannabis, Sativex®, codeine phosphate, dihydrocodeine tartrate, ethylmorphine, glutethimide, ketamine, nabilone, pentazocine, phenmetrazine, and pholcodine.
Class C includes certain drugs related to the amfetamines such as benzfetamine and chlorphentermine, buprenorphine, mazindol, meprobamate, pemoline, pipradrol, most benzodiazepines, tramadol hydrochloride, zaleplon, zolpidem tartrate, zopiclone, androgenic and anabolic steroids, clenbuterol, chorionic gonadotropin (HCG), non-human chorionic gonadotrophin, somatotropin, somatrem, somatropin, gabapentin, and pregabalin.
The Misuse of Drugs Regulations 2001 (and later revisions) outline the types of people who can provide and possess Controlled Drugs while functioning in their professional roles, as well as the conditions under which they can do so. Drugs are separated into five Schedules in the 2001 rules, each of which specifies the requirements that apply to them, such as import, export, manufacture, supply, possession, prescription, and record keeping.
Drugs, substances, or compounds classified as Schedule I are those that have no currently accepted medical use and have a significant potential for misuse, having a high risk of being abused and/or causing severe psychological and/or bodily dependency.
Hallucinogenic drugs (e.g. lysergic acid diethylamide (LSD)), ecstasy-type compounds, raw opium are all classified as Schedule I narcotics. A Home Office licence is usually necessary for their manufacture, possession, or distribution.
A Controlled Drug Register must be used to keep track of any Schedule I Controlled Drugs that a pharmacy receives or supplies.
Schedule II substances, drugs, or chemicals are those that have a high potential for misuse and can lead to severe psychological or physical dependence if used.
Opioids (such as diamorphine hydrochloride (heroin), morphine, methadone hydrochloride, oxycodone hydrochloride, and pethidine hydrochloride), major stimulants (such as amfetamines), quinalbarbitone (secobarbital), cocaine, ketamine, and cannabis-based products for medicinal use in humans are all included in Schedule II. Except for quinalbarbitone (secobarbital) and some liquid preparations, Schedule II Controlled Drugs are subject to all Controlled Drug regulations, including prescriptions, safe custody, and the necessity to keep a Controlled Drug register (unless exempted in Schedule V). Pharmacists and other professionals listed in the 2001 Regulations can possess, supply, and procure a Schedule II substance.
Barbiturates (excluding secobarbital, which has been moved to Schedule II), buprenorphine, gabapentin, mazindol, meprobamate, midazolam, pentazocine, phentermine, pregabalin, temazepam, and tramadol hydrochloride are all included in Schedule III. They must follow the unique prescription guidelines. Except for any 5,5 disubstituted barbituric acid (e.g. phenobarbital), gabapentin, mazindol, meprobamate, pentazocine, phentermine, pregabalin, tramadol hydrochloride, or any stereoisomeric form or salts of the foregoing, safe custody standards apply. It is not necessary to keep records in registers (although there are requirements for the retention of invoices for two years).
Benzodiazepines (excluding temazepam and midazolam, which are in Schedule III), non-benzodiazepine hypnotics (zaleplon, zolpidem tartrate, and zopiclone), and Sativex® are among the medications under Schedule IV in Part I. Clenbuterol, chorionic gonadotropin (HCG), non-human chorionic gonadotrophin, somatotropin, somatrem, and somatropin are all included in Part II. Prescription requirements for controlled substances do not apply, and Schedule IV substances are not subject to safe-keeping regulations. Except in the case of Sativex®, there is no need to keep records in registers.
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Schedule V comprises formulations of some Controlled Drugs (such as codeine, pholcodine, or morphine) that are free from practically all Controlled Drug restrictions, with the exception of the two-year preservation of invoices, due to their low potency.
While not all prescription pharmaceuticals are considered restricted substances, some are (for example, opioid pain relievers). If your doctor gives you one of these medications, it’s critical that you take it exactly as prescribed.
In addition to having limited refills, you may be required to sign a pain medication agreement between you and the doctor, to ensure that you’re taking the medications exactly as prescribed. While the specifics may differ from doctor to doctor, you may be asked to consent to:
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This is the grouping system used by the Misuse of Drugs Act to reflect how dangerous a substance is.
Drugs are grouped into a ‘Class’ - either A, B or C according to their risk level, with Class A substances the most dangerous.
This is the grouping system used by the Misuse of Drugs Regulations to reflect the different
restrictions that apply to the prescription and monitoring of controlled drugs used for medical
purposes. Drugs are grouped into one of five ‘Schedules’ with Schedule 1 having the tightest
controls.
The Home Office maintains the central list of UK controlled drugs and reviews this list periodically.
Changes to the list can only be made after the Advisory Committee on the Misuse of Drugs (ACMD) has advised the Home Office that changes should be made and a full Public Consultation has taken place.
Drugs can be “up-classified” if stronger controls need to be in place or can be down-classified
if a substance has been shown to pose less of a safety risk to patients and the public.
The reclassification of substances can affect how physiotherapists prescribe and/or administer controlled drugs, particularly if the drug is made a controlled drug or is moved into a higher classification that has tighter controls on its use.
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