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Letter to the Home Office - Supply of controlled drugs

A pharmacist behind the counter writing on a piece of paper

The Home Secretary has this week amended the Misuse of Drugs Regulations 2001, providing Ministers with emergency powers concerning the supply of controlled drugs such as morphine in specified circumstances during a pandemic.

Ministers now have the option to trigger additional flexibilities during the covid-19 pandemic, such as allowing pharmacies to supply controlled medication without a prescription. Also, to allow supply of alternative medications should there be a shortage of a drug, this permits on-going treatment with alternative products where prescribed items are unavailable or are in short supply. The legislation also allows pharmacists without prescribing rights to change the frequency of instalments on prescriptions without the need for a new prescription from the prescriber.

We welcome the Home Secretary’s move last week to lay before parliament legislation which would allow some loosening of the regulations for controlled drugs. Given the urgency with which prescribers and pharmacists need to provide pain control and reduce severe breathing difficulty for patients with covid-19 this legislation needs to be enacted urgently.

We call on the Home Secretary to trigger the useful actions contained in the legislation without delay as this will benefit health care staff and most importantly patients.

Signed: Dr Yasir Abbasi – Maudsley Health Professor John Ashton – former president of the UK Public Health Association Dr Rachel Britton – Director of Pharmacy, We Are With You Professor Julia Buxton – Central European University Dr Patricia Cantley – NHS Consultant, Edinburgh Anna Codrea-Rado – Journalist, London Professor Nicky Cullum – University of Manchester Chris Daw QC – Serjeants’ Inn, London Paul Delaney – coAim, Wexford. Niamh Eastwood, Release, London Dr Suzanne Gage – University of Liverpool Dr Matthew Gaskell – Consultant Psychologist, Leeds Professor Simon Gilbody – University of York Vanessa Gilmartin – Sociable Angels Ltd, Leeds Roz Gittins – Humankind Emily Goddard – Journalist, Bedfordshire Ian Hamilton – University of York Dr William Haydock – Senior health programme advisor Nick Hickmott – We Are With You, Kent Dr Samei Huda – Pennine Care NHS Foundation Trust Professor Elizabeth Hughes – University of Leeds Professor Sonia Johnson – University College London John Jolly – ex CEO Blenheim Drug Project Arfon Jones – Police and crime commissioner North Wales Danny Kushlick – Campaigns Consultant, Bristol Dr Garrett McGovern – Priority Medical Clinic, Dublin Dr David Manley – Nottinghamshire NHS Foundation Trust Dr Sally Marlow – Kings College London Professor Fiona Measham – University of Liverpool Dr Mark Monaghan – University of Birmingham Mark Moody – CEO, Change Grow Live Dr Rajesh Mohan – South London & Maudsley NHS Foundation Trust Steve Moore – Centre for Medicinal Cannabis Professor Marcus Munafo – University of Bristol Dr Russell Newcombe – 3D research, Liverpool James Nichols – Transform Drug Policy Foundation Professor David Nutt – Imperial College London Professor Jolanta Opacka – University of Roehampton Mike Power – Journalist, London Dr Rob Ralphs – Manchester Metropolitan University Jason Reed – Law Enforcement Action Partnership Steve Rolles – Transform Drug Policy Foundation Dr Tony Rao – South London & Maudsley NHS Foundation Trust Professor Toby Seddon – University of Manchester Professor Alex Stevens – University of Kent Professor Harry Sumnall – Liverpool John Moores University Dr Andre Tomlin – The Mental Elf, Bristol. Russell Webster – Consultant, Essex Jo-Anne Welsh – CEO Oasis Project Professor Robert West – University College London Dr Emma Williams – Canterbury Christ Church University Professor Adam Winstock – University College London Dr Judith Yates – International Doctors for Healthier Drug Policies

Since sending this letter to the Home Office, Priti Patel has responded to the recommendations made by Professor Ian Hamilton.

Dear Ian,

Thank you for your email of 4 May containing an open letter signed by a number of medical professionals and others, about the Misuse of Drugs (Coronavirus) (Amendments Relating to the Supply of Controlled Drugs During a Pandemic etc.) Regulations 2020 (“the 2020 Regulations”). You and your co-signatories suggested that all three of the measures should be implemented immediately.

As you are aware, the measures in the 2020 Regulations would:

• allow registered pharmacies to supply certain substances without a prescription, where the patient has been receiving them as part of ongoing treatment; • allow the supply of substances under a Serious Shortage Protocol to enable ongoing treatment with alternative products where prescribed items are unavailable or are in short supply nationally; and • allow pharmacists without prescribing rights to change the frequency of instalments on instalment prescriptions without the immediate need for a new prescription.

The amendments are enabling and are only intended to be used in limited circumstances where demand or workforce pressures during a pandemic meant that local health services were at imminent risk of failing to fulfil their duties or there is a national shortage of a specified controlled drug. There will be no changes to practice until an announcement is made by a Secretary of State. The supply of medicines is the policy responsibility of the Department of Health and Social Care (DHSC) and the NHS and it would therefore be the Secretary of State for Health and Social Care who will decide when to use these powers and make the announcement setting out the conditions of supply.

Although the measure enabling the supply of medicines without a prescription, for example, may be applied across the whole of Great Britain, or the whole of England, Wales or Scotland, it could also be implemented in a relatively small geographical area, for example, a specific town or the area from which a GP practice that has been forced to close has accepted patients onto its patient list. The geographic scope will be determined by the extent of need. An announcement which affects all or any area of Scotland or Wales would be made following consultation with Scottish or Welsh Ministers.

I would also encourage you to read the thoughtful advice from the Advisory Council on the Misuse of Drugs (ACMD) on the measures. The ACMD expressed support for the measures but also urged caution on a number of aspects of their implementation, which will be taken into account in any future use of the measures. The Royal Pharmaceutical Society has also issued guidance on these new measures and the NHS is developing operational guidance in consultation with the relevant professional representative bodies.

I have shared your letter with the Health Secretary. I can assure you that the Government is working hard to ensure the supply of all essential medicines where there is urgent need and that the Government will continue to make every effort to ensure that all patients receive the best possible care during the pandemic.

Priti Patel

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