1. Purpose and Scope
The purpose of this policy is to establish a safe, consistent, and legally compliant framework for prescribing Controlled Drugs (Schedules 2–5) and other high-risk, dependence-forming medications across the Practice.
This policy applies to all healthcare professionals, administrative staff, and patients registered with the Practice. It aligns with the National Health Service (General Medical Services Contracts) (Scotland) Regulations, General Medical Council (GMC) prescribing standards, Scottish Intercollegiate Guidelines Network (SIGN) guidance, NICE guidance (NG46), the Misuse of Drugs Regulations 2001 (as amended), and Scottish Government guidance on the Safer Management of Controlled Drugs in Primary Care.
2. Scope of Medications Covered
This policy applies to all Controlled Drugs and medications liable to misuse, addiction, or diversion, including but not limited to:
- Opioids: Morphine, Oxycodone, Fentanyl, Buprenorphine, Tramadol, Codeine, Co-codamol.
- Benzodiazepines: Diazepam, Lorazepam, Nitrazepam, Temazepam.
- Z-Drugs: Zolpidem, Zopiclone.
- Gabapentinoids: Gabapentin, Pregabalin.
- CNS Stimulants & Other Dependence-Forming Medications.
3. Indicators of High-Risk / Drug-Seeking Behaviour
Staff and prescribers must remain vigilant for behaviors that may indicate medication misuse, dependency, or diversion:
- Frequent early or urgent repeat prescription requests.
- Repeated reports of lost, stolen, or spilled medications.
- Demands for specific brand names, doses, or drug classes without clinical justification.
- Escalating dose demands or refusing non-pharmacological/alternative treatments.
- Concurrent attendance or attempts to obtain supplies from multiple GP practices, NHS 24, Out-of-Hours (OOH) services, Emergency Departments, or private clinics.
- Aggressive, coercive, or manipulative behavior toward practice staff.
- Refusal to engage in regular medication reviews, blood monitoring, or urine drug screening (UDS).
4. Practice Prescribing Rules & Principles
4.1 New and Long-Term Prescriptions
- Avoidance of Long-Term Use: As a general rule, the Practice does not initiate long-term opioids, benzodiazepines, or Z-drugs for chronic non-cancer pain or non-acute anxiety.
- 28 to 30-Day Limit: In line with NHS Scotland and national safety guidelines, routine prescriptions for Controlled Drugs will strictly be restricted to a maximum of 28 to 30 days’ supply at a time.
4.2 Lost, Stolen, or Early Replacement Requests
- No Automatic Replacements: The Practice operates a strict policy of not automatically replacing lost, stolen, or damaged prescriptions for Controlled Drugs or dependence-forming medications.
- Exceptional Circumstances: Any exception requires a documented clinical risk assessment by a GP Partner. Stolen medication claims must be accompanied by an official Police Scotland Incident Reference Number.
4.3 Supervised Consumption and Controlled Dispensing
Where clinical dependency, safety concerns, or misuse are identified, the Practice may institute controlled dispensing regimes (e.g., weekly, daily, or pharmacy-supervised consumption) in formal agreement with a local community pharmacy.
5. Governance, Escalation, and List Management
5.1 Clinical Review and Tapering Plans
Prescribers will conduct structured medication reviews. Where appropriate, a safe, agreed-upon reduction and deprescribing plan will be established alongside supportive management (e.g., referral to NHS Pain Management Services or local Alcohol and Drug Partnerships / Addiction Services).
5.2 Written Warning / Patient Agreement
If a patient breaches prescribing boundaries, coerces staff, or fails to adhere to safe treatment plans, a formal written warning or Controlled Drugs Agreement outlining practice expectations will be issued.
5.3 Removal from the Practice List
In accordance with GMC guidelines and NHS Scotland GMS Regulations:
Standard Removal: Patients will not be removed solely for having a substance dependency or exhibiting drug-seeking behaviors. However, persistent refusal to engage with safe treatment plans, repeated breakdown of the therapeutic relationship, or breach of formal warnings may result in a formal request to the local NHS Health Board Practitioner Services for removal from the practice list.
Immediate Removal: Any physical violence, threat of violence, or severe abusive/intimidating behavior toward staff will result in immediate removal under the NHS Scotland Zero Tolerance Policy, reporting to Police Scotland, and notification to the local NHS Health Board.