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Tramadol faces reclassification after surge in deaths

Practice Tramadol could be reclassified as a class C drug under government plans to tackle a recent surge in deaths involving the prescription painkiller.

Tramadol could be reclassified as a class C drug under government plans to tackle a surge in deaths involving the prescription painkiller.

The move would see the drug placed in schedule 3 of the Misuse of Drugs Regulations 2001, making it "consistent" with the scheduling of other opioids for treating moderate to severe pain, the Home Office said in a consultation launched on Monday (July 22).     

The drug would still be available on prescription for patients who need it, but the rescheduling would mean access "will be appropriately restricted," it said.  

Tramadol's reclassification to schedule 3 would mean patients would have to physically take the prescription to a pharmacy for dispensing

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Tramadol's move to schedule 3 should mean no extra costs to pharmacists as they have safes to store controlled drugs already, the Home Office said, adding that it would mean patients having to physically take the prescription to a pharmacy for dispensing.   

The Home Office launched the 12-week consultation in response to an investigation by the Advisory Council on the Misuse of Drugs (ACMD).  

In February, the ACMD called for tramadol to be placed under tighter control because it found the number of deaths involving the analgesic had almost doubled from 83 in 2008 to 154 in 2011. The drug was widely available online, easily obtainable without a prescription and most tramadol-related deaths occurred when the drug was obtained through non-prescribed means, it found. 

In the same consultation, which runs until October 11, the Home Office has also proposed plans to remove restrictions on prescriptions for the widely misused temazepam.

Temazepam will remain in schedule 3, but the requirement for a handwritten signature will be removed. This option would "provide an appropriate level of control for temazepam without introducing excessive burdens on the prescribers", it said.

This would align temazepam with recent changes allowing prescriptions for schedule 3 drugs to be computer generated, the Home Office added.

How would controlled-drug status for tramadol affect your patients taking the painkillers?

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SHABBIR.J ABDULHUSSEIN., Community pharmacist

I propose that every pharmacy contactor get a £1000 as a one off payment to help obtain a
large cd cupboard to accomodate those huge piles of tramadols.If any extra admin work is
mandatory then perhaps the Lawlords could provide some extra funding.Come on PSNC,there is a job for you.....

N O, Pharmaceutical Adviser

Also, how long will they allow for the pharmacies to make necessary arrangements, such that they can have a control on the existing stock levels and arrange for new storage facilities complying the legislation?

J D, Community pharmacist

even if we got new cabinets... where would they go! most dispensaries are small and packed.

N O, Pharmaceutical Adviser

I have worked in pharmacy where the minimum back up stock for Tramadol 50mg capsules is 30 X 30caps. Just imagine how many CD Cupboards they may have to purchase ?? or imagine the waiting times for patients in absolute pain??

Adina Brown, Community pharmacist

If I was to transfer stock of tramadol on my shelves into the CD cupboard the others. will be falling out. There just isn,t the space!!!!!!!

Z ZZzzzz, Information Technology

Can't see how extra legislation will stop the online trade. I would imagine most of that would be from patients that are over prescribed it in the first place!

Can't believe the Home Office thinks the possible extra safe custody arrangements won't have a financial implication for contractors.

Also can't believe the Home Office is unaware of distance selling pharmacies where the patient is not allowed to physically visit the pharmacy presence.

Perhaps I are giving the Home Office more credit than they obviously deserve.


Z ZZzzzz, Information Technology

Should read

Perhaps I am......

(Predictive text can be such a pain in the neck.)

Calum Nelson, Locum pharmacist

This will be a logistical nightmare. As well as the storage, there'll be the need for words and figures etc on scripts, the 28 day validity, CD destruction requirements and so on. How many tramadol prescriptions are going to have to be sent back to prescribers to be changed?

The way CDs are scheduled makes little sense. Tramadol in sch3, diazepam in sch4, morphine liquid in sch5, not to mention all the exemptions for various drugs from various requirements (which no-one seems to have a reason for, and I've asked around, yet never get simplified)

Yassin Dickie, Community pharmacist

If they have to be returned on account of some legal nicety so be it. Is it worth a trip to see the G.Ph.C. and/or a fine/jail time/suspension/removal from the register.? A death sentence is about the only penalty missing for pharmacists. My understanding of the law is that it also a criminal offence for a prescriber to write a faulty CD prescription, not just for us to accidentally dispense it. Wonder when the first GP will be prosecuted.? LOL

max falconer, Superintendent Pharmacist

Ridiculous! No extra cost to pharmacies...what a joke... At our expense as usual obviously.
I have far more tramadol on my shelves than all the other CDs put together. No way should we endorse this decision unless fully funded so no losing it in the 'global sum' PSNC. We need proper and full specific funding for this.

K Patel, Community pharmacist

psnc should arrange for each pharmacy to get funds for a new cd cabinet individually. SOME HOPE they dont negotiate anything. just give in!

Keith Seston, Other pharmacist

"Tramadol's move to schedule 3 should mean no extra costs to pharmacists as they have safes to store controlled drugs"
I would have thought that anyone working for C&D would have some sense of the working of a community dispensary and realise that the amount of tramadol used by most pharmacies would not fit in existing CD storage
Poor journalism and not helpful in achieving funding for the exta storage required

Jennifer Richardson, Editorial

Hi Keith,

The statement you quote was actually the Home Office's assessment of the situation - in its impact assessment of the proposals.

It says under 'Evidence base - E. Appraisal (costs and benefits) - General assumptions and data - Business (p7): "Pharmacies which currently store tramadol for retail to the public and other businesses that store controlled drugs will already have compliant safes for this purpose... We assume that almost all businesses which deal in tramadol will not need to buy a new safe as a result of the legislative change and will be able to accomodate stocks of tramadol in current safes... Total costs to the business as a result of the legislative change will therefore be negligible."

Apologies for any confusion that led to your assumption that this was C+D's assessment and thanks for pointing out that this wasn't clear - we have edited the story to make it clearer that it was the Home Office's assessment.

If you want to respond to the consultation to challenge this assumption in the impact assessment, you can do so here - or you could perhaps contact a pharmacy representative body of which you are a member to feed into its response.

Syed Faisal Hussain, Community pharmacist

Already the Cd cabinets have no room in some Pharmacies, now I can see the shares doing well for the Cd cabinet manufacturers!

K D, Locum pharmacist

Unless they treat it like phenobarbital and make it exempt from safe custody requirements.

Mike Hewitson, Superintendent Pharmacist

Of course, it is going to be a pain in the rectum.

Mike Hewitson, Superintendent Pharmacist

Hurrah! About time tramadol was recognised as a menace!

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