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NPA: Pharmacists must understand pregabalin and gabapentin changes

Pharmacy manager Sadik Al-Hassan said the switch has caused more work

The National Pharmacy Association (NPA) has urged pharmacists to get up to speed on changes to handling pregabalin and gabapentin, which come into force today.

In October, the Home Office announced that from today (April 1) the drugs – used to treat anxiety, nerve pain and epilepsy – would be placed in schedule 3 under the Misuse of Drugs Regulations 2001, but would be excluded from the requirement to be stored in a safe.

Speaking ahead of the reclassification last week, Leyla Hannbeck, the NPA’s director of pharmacy, said that pharmacists need to be aware of how to comply with the change in the law; for example "that [pregabalin and gabapentin] can’t be given under an emergency supply”.

Even though the medicines do not need to be in a safe, pharmacists still need to comply with the safe standards of storage, Ms Hannbeck advised (see more below).

“Pharmacy communicates changes to patients”

Vikesh Patel, the clinical lead for north-east London local pharmaceutical committee, claimed that his local surgeries had stopped prescribing the medicines electronically three weeks ago, but it was left to pharmacy teams to communicate to patients why they were having to pick their prescriptions up from GP practices.

“That burden fell on the pharmacy, which was not fair,” claimed Mr Patel, who is also superintendent pharmacist of several branches.

However, staff have had no trouble implementing the changes in handling pregabalin and gabapentin because they had previous experience of the switch with tramadol, from schedule 4 to 3 in 2014, he said.

Mr Patel has no concerns about the reclassifications, as he appreciates they aim to improve medicines safety, he said.

“Adding another layer to the control shows the importance of the drug and [highlights] how easy it is to abuse.”

Additional workload

Sadik Al-Hassan, the manager of a Well branch in Bristol, said the switch “has created quite a bit of additional workload”.

The changes “meant we had to look at the effect on some of the services we offer, but Well provided some great support to help our team at the beginning of March”, he told C+D.

He oversaw a campaign in his pharmacy, which dispenses gabapentin and pregabalin daily, to educate patients on the changes.

His team had been talking to patients about how the changes would affect them since February, he said.

“Without the work we have done as a pharmacy team, I don't believe patients would be aware until the switch occurred.”

The reclassification may reflect the “growing problem of abuse” with these medicines, he said.

NPA recommendations

Under the reclassification, prescriptions for pregabalin and gabapentin must be signed by the prescriber, and include a clearly defined dose, correct formulation and strength where appropriate, the NPA said in guidance outlining the changes.

Prescriptions will only be valid for 28 days, the NPA continued, and although not a legal requirement, the “strong recommendation” from the Department of Health and Social Care and Scottish government is for a maximum of 30-days supply unless the prescriber has provided justification for a longer supply, the NPA said.

A national rollout of schedule 2 and 3 controlled drugs via the electronic prescription service (EPS) is currently underway. The Pharmaceutical Services Negotiating Committee has advised pharmacy teams to refer to NHS Digital’s schedule to identify when their local GP practices are due to go live.

9 Comments
Question: 
Have you had many questions from patients about the reclassification of pregabalin and gabapentin?

Leon The Apothecary, Student

I've found the last two weeks the biggest teething problem has been the GP surgeries not understanding the changes. They are getting there, but the NPA should recognise the work that pharmacy teams have had in educating other healthcare professionals.

R A, Community pharmacist

My issue is dealing with the aggression of the recipient of the prescription.  

Leon The Apothecary, Student

Generally? I heard a horrific story recently of a patient squaring up to a disabled counter assistant because they allowed themselves to run out of medication and arrived at a pharmacy just before they closed, and without the required information available was refused an emergency supply.

My hope is that the police were notified and that particular person faces a criminal charge of threat of violence. That kind of behaviour does not belong in a pharmacy, or anywhere else for that matter!

Lucky Ex-Locum, Superintendent Pharmacist

At least you won't be ABLE to do emergency supplies of Pregabalin and Gabapentin now. I never felt comfortable doing that.

Debbie Kemp, Pharmacy technician

Biggest problem we have is surgeries not writing additional info: CD and amount in words and figures as will not let you dispense the item without this info electronically.

Lucky Ex-Locum, Superintendent Pharmacist

EMIS systems were doing this at the end of February. Which system does your local surgery use?

Lucky Ex-Locum, Superintendent Pharmacist

It's not exactly rocket science is it? My only concern is the amount of prescriptions for 100 capsules tds we are going to have to knock back. I wonder if the manufacturers will help us out by supplying packs of 84? I'm not holding my breath.

Leon The Apothecary, Student

None - technicially. There's no actual restriction on duration, just a recommendation.

You could send a note to the prescriber, record this on PMR as well, and you would have done your part. Although, packs of 28 would be great.

Lucky Ex-Locum, Superintendent Pharmacist

True. the GP just gets a list of CDs with greater than 28 days supplied for them to ignore at their leisure. 

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