Focus on monitoring the sale and supply of medicines subject to abuse or misuse

In this article, we look at a range of examples of notable practice where pharmacies have addressed the risks of selling and supplying medicines likely to be abused or misused

February 2022

Pharmacy teams should be aware of potential prescription medicines diversion, where legally prescribed medicines are transferred to another person. They should also be aware of medicines that are liable to abuse or misuse, whether on their own or in combination with other substances as pharmacy teams have a key role in preventing harm and improving health.

Our standards for registered pharmacies require pharmacy owners to have systems in place to identify and manage the risks associated with the supply of medicines, including the supply of high-risk medicines.  Safeguards should be in place to make sure that sales and supplies of these medicines can be managed safely and appropriately, including having controls in place to stop repeat sales or to identify trends in requests.

One example of a high-risk medicine is codeine linctus.  Since July 2020, we have taken enforcement action against 43 pharmacy premises and a pharmacy professional following intelligence-led inspections or investigations relating to unusually high sales of codeine linctus.

Pharmacies working with online prescribing services who deal with repeated sales and supplies of habit-forming painkillers and Z-drugs still remain a risk.  The supply of these medicines is subject to checks to make sure that they are supplied safely.

Our guidance for registered pharmacies providing pharmacy services at a distance, including on the internet sets out what pharmacy owners should consider before deciding whether any parts of their pharmacy service can be provided safely and effectively at a distance (including on the internet), rather than in the traditional face-to-face way.

While pharmacies are expected to have sufficient checks in place, the quality of checks can vary between pharmacies. Our recently published guidance on how we manage concerns about the online sale and supply of habit-forming medicines gives examples of poor practice, and further information on how we manage concerns about the online sale and supply of habit-forming medicines and those liable to abuse or overuse.

Below are examples from our knowledge hub of notable practice on monitoring sales and supplies of medicines subject to abuse, misuse or overuse.

Understanding how to sell over-the-counter codeine-containing medicines safely

To assess the risks associated with selling codeine-containing medicines over the counter, one pharmacy’s team members have engaged in additional learning to manage requests for these medicines. This includes having governance arrangements which include the use of a written checklist to support team members to take a consistent approach to managing requests. It also makes sure each sale is authorised by a pharmacist. This checklist is used alongside a monthly audit of wholesale purchases to support the pharmacy in monitoring the safe receipt and supply of these high-risk medicines. 

Reviewing how over-the-counter medicines which may be liable to abuse or misuse are sold

To help inform learning to support the safe sale and supply of medicines, one pharmacy uses information gained from pharmaceutical media publications. The pharmacy’s most recent learning focussed on GPhC enforcement action concerning codeine linctus, and also addressed police concerns about the supply of over-the-counter medicines subject to abuse or misuse. The learning has led to the team reviewing and strengthening its processes for managing requests for these medicines.

Applying safeguarding learning to practice

One pharmacy team engaged in regular safeguarding training which included understanding the different types of safeguarding concerns that could arise when providing NHS pharmacy services at a distance. The pharmacy successfully monitored the dispensing frequency of high-risk medicines subject to abuse or misuse and, where necessary, the pharmacist contacted the prescriber and patient to address any concerns. The pharmacy kept a record of these interventions within the patient’s medication records. This process allowed the team to monitor the frequency of dispensing of high-risk medicines and the interventions made.

See further examples of notable practice in our knowledge hub

Published on