'Increased cost' for pharmacies under pregabalin controlled drug plans

The Home Office is consulting on three options to reclassify pregabalin and gabapentin
The Home Office is consulting on three options to reclassify pregabalin and gabapentin

Community pharmacies might be hit with extra storage costs if government plans to reclassify pregabalin and gabapentin as controlled drugs are approved.

The 10-week Home Office consultation – which launched on Monday (November 13) – proposes three options for the reclassification of the two drugs.

The first – and "preferred option" – is placing the drugs in schedule 3 under the Misuse of Drugs Regulations 2001 and requiring them to be stored in safes.

If the government selects this option, "some organisations such as community pharmacies" may face the "increased costs" of acquiring additional safes to store the drugs in, according to the Home Office's impact assessment.

"[This option] would provide the largest benefit to society to prevent the two drugs being diverted into the illicit market, owing to the requirement to store the drugs in safes," the Home Office said.

"However, some organisations – such as community pharmacies – may struggle to store the two drugs in their existing safes and may need to acquire additional safes if the safe custody provisions apply."

The other two options for reclassification are: for pregabalin and gabapentin to be placed under schedule 3 without the need to be stored in safes; or to be placed under schedule 4 part 1 – alongside drugs such as lorazepam and diazepam.

Reclassifying the two drugs and storing them in safes was recommended by the Advisory Council on the Misuse of Drugs (ACMD) in January 2016, the Home Office pointed out.

At the time, the ACMD suggested that pregabalin and gabapentin should become class C drugs, noting that their "risk of addiction, potential illegal diversion and medicinal misuse" are equivalent to existing class C drugs such as tramadol.

Pharmacists have until January 22, 2018 to submit their responses to the consultation via an online questionnaire.

13 Comments
Question: 
What impact would the reclassification of pregabalin and gabapentin have in your pharmacy?

Farnosh Fariba, Industrial pharmacist

The submission that went to the Parliament needs to be read in full in order to understand the  earlier comment in context. I fully agree that  trying to fit three shelves full of pregabalin into a   CD cabinet of a retail pharmacy is not practical. It is also unreasonable to burden pharmacists with more paperwork, given the existing pressures. This is a consultation stage and the article does not explain the clinical reasons that were submitted to the Parliament. 

Caroline Jones, Community pharmacist

It's more to do with inappropriate prescribing; and the subsequent diversion of medication. Pregabalin especially is dished out on a whim now; most patients know they can get it prescribed if the continue to complain of pain once a NSAID has been tried followed by a short course of Diazepam! And that's not including the millions of people claiming anxiety.......

Farnosh Fariba, Industrial pharmacist

This is not about storage. It is about the severe propensity for addiction and impact on patient safety. I took the submission to the Parliament on behalf of patients. An email on 22nd September confirmed that gabapentanoids will be made Class C drugs. This was not accepted as sufficient restriction for pregablin. The labelling does not give adequate health and safety warnings to patients and prescribers. Gabapentin is expected to become a schedule 3 controlled drug and pregabalin may become schedule 2. Any restriction on prescribing based on clinical data & better prescriber information is a move in the right direction. 

A Hussain, Senior Management

Whether they are in a cd cabinet or not, I won't be selling them to members of the public.

Stephen Walsh, Community pharmacist

From a PRACTICAL standpoint in community pharmacy, this is ABSOLUTELY about storage. I cannot speak for hospital as I have no experience in that field. Do you have experience in either of these two fields to base your assertions on?

 I am unsure if you are aware of the physical space these things actually take up? To fit them in an existing CD cupboard in most pharmacies is not going to happen. To fit a new cupboard capable of storing these items both before and after dispensing in many places may also be impractical and also a health and saftey risk.

The cost of a suitable cupboard is anything from a few hundred to over a thousand pounds plus VAT. Who will be funding this cost I wonder....

The vast majority of pharmacies are alarmed and protected overnight. I believe this is using a sledgehammer to crack a nut. 

The move to Sch 4 or 3 without safe storage is fine and I support this fully.

Locum Pharmacist, Locum pharmacist

Let's make it Schedule 4 if we have to class it as a CD. I do not want to have to refer more prescriptions to prescribers because the dosage instructions do not meet legal requirements and expect prescribers feel the same way. Especially if patients are taking these medicines for epilepsy.

It would be better to advise/warn prescribers on addiction risk etc in order to reduce prescribing- it is not like pharmacists are issuing these medicines without a prescription so locking them up and giving us more paperwork seems rather pointless.

Dave Downham, Manager

At least they are small boxes with only a few strengths so won't take up much space. Oh, wait!...

S Patel, Superintendent Pharmacist

Surprised they havent released gabapentin/pregablin sized XMAS advert calendars yet in the run up for XMAS

Stephen Eggleston, Community pharmacist

I don't see how storing it in a safe in the pharmacy has any impact on it being diverted in to the illicit drug market. If they must do this, then surely it is reasnable that they pay every pharmacy an amount to enable them to add the extra secure storage

Andy Burrells, Community pharmacist

If a POM goes missing, nothing more than a slap of the wrist occurs. If a Sch2 or 3 drug goes missing, people lose their jobs. 'Diversion' as it is being termed occurs in most wholesalers... At least an audit trail will massively reduce this

Jack Shanahan, Community pharmacist

What useful purpose is served by keeping pregabalin and gabapentin in the safe? Where is the public benefit? It seems to be regulation for the sake of over-regulation. CD4.1 is enough and puts sufficient controls in place

David Moore, Locum pharmacist

Haven't we been here before, with tramadol? We'll have the same problem with pregabulin and gabapentin. We don't have sufficient storage space.

Andy Burrells, Community pharmacist

I've not noticed any change in the prescribing of Tramadol since 2014... But I have noticed more hassle.

Its no longer the envogue street drug, and nor will Gabbies or Pregab be in a few years

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