⚕️Care Handbook

Controlled Drugs Procedures

Controlled drugs (CDs) are medicines regulated under the Misuse of Drugs Regulations 2001 due to their potential for misuse and dependence. Care homes must have robust procedures for their management.

Legal Framework

The control of CDs in care homes is governed by:

  • •Misuse of Drugs Act 1971 — classifies drugs into Classes A, B, and C based on harm potential
  • •Misuse of Drugs Regulations 2001 — schedules drugs (Schedules 1–5) based on medicinal use and misuse potential
  • •Misuse of Drugs (Safe Custody) Regulations 1973 — specifies storage requirements for CDs
  • •Controlled Drugs (Supervision of Management and Use) Act 2006 — following the Shipman Inquiry, introduced accountable officers

CD Schedules

The 2001 regulations classify controlled drugs into five schedules, each with different levels of control. The schedules replaced the previous system of Schedules 1–5 (which were previously called CD1–CD5).

Schedule 1

Examples:Cannabis, LSD, MDMA, heroin (for research only)
Storage:Not normally held in care homes
Requirements:Rarely used in clinical practice; Home Office licence required for possession.

Schedule 2

Examples:Morphine, diamorphine, fentanyl, oxycodone, methadone, pethidine, methylphenidate
Storage:Within a locked CD cabinet, separate from other medication. Must be in a dedicated CD safe or cupboard fixed to the fabric of the building.
Requirements:Full CD register required. Each receipt and administration must be recorded. Dual signing (two authorised witnesses) for administration and stock counts. Running balance must be maintained.

Schedule 3

Examples:Temazepam, buprenorphine, midazolam, pregabalin (from April 2019), gabapentin (from April 2019), ketamine, tramadol
Storage:Locked medicine cupboard (does not require a dedicated CD cabinet but must be stored securely).
Requirements:No register required, but records of receipt and administration must be kept in line with organisational policy.

Schedule 4 (Part I)

Examples:Diazepam, lorazepam, zopiclone, zolpidem, nitrazepam
Storage:Locked medicine cupboard.
Requirements:No special record requirements beyond standard MAR chart documentation and standard stock control.

Schedule 4 (Part II)

Examples:Anabolic steroids, growth hormones
Storage:Locked medicine cupboard.
Requirements:Rarely used in care homes. No special record requirements.

Schedule 5

Examples:Low-dose codeine preparations, kaolin and morphine mixture
Storage:General medicine storage.
Requirements:Minimal control requirements. Standard MAR chart documentation applies.

Administration of Schedule 2 CDs

  • 1.Check the prescription and MAR chart
  • 2.Check the CD register — confirm the current stock balance
  • 3.Two authorised staff must witness the administration (the administrator and a witness)
  • 4.Check the resident's identity, the drug name, dose, route, and time (5 Rights)
  • 5.Remove the required dose from stock and check the remaining balance
  • 6.Administer the medication
  • 7.Both staff sign the CD register and the MAR chart immediately
  • 8.Record any part-doses (e.g. if a tablet was halved) and the quantity wasted or destroyed

Stock Checking & Record Keeping

  • •A running balance must be maintained in the CD register for all Schedule 2 drugs
  • •CD stock counts must be performed at every shift change by two authorised staff
  • •Both staff must confirm the count and sign the register
  • •Any discrepancy between the expected and actual stock must be investigated immediately
  • •Report discrepancies to the registered manager and the CQC (if a significant quantity)
  • •CD registers must be kept for 2 years after the date of the last entry (Schedule 2) or as per organisational policy
  • •Entries must be made in ink — no correction fluid or erasing; errors should be crossed through, initialled, and the correct entry written alongside

Destruction of Controlled Drugs

Controlled drugs must never be disposed of in normal waste. Schedule 2 CDs must be destroyed in the presence of an authorised witness (typically a pharmacist, police officer, or other authorised person). The destruction must be recorded in the CD register with the date, quantity destroyed, signatures of the destructor and witness. Expired or discontinued CDs should be separated from current stock and clearly labelled pending destruction. Contact your community pharmacist to arrange witnessed destruction.