Controlled Drugs and PMs FAQ

when authorising human medicines (prescription medicines (pms)), for example gabapentin and/or controlled drugs, for example phenobarbitone, for patients that are very likely to require it long term; how often must the veterinarian examine the patient to be able to authorise these medications? this is a common question and it will be answered below in two parts this first part relates to how much can be authorised and dispensed each time, and the second part is what must happen for a new authorisation how many months’ supply can i authorise and dispense at a time? looking at the code of professional conduct (copc), this describes the actions veterinarians must take when authorising medicines in 6 veterinary medicines 6 veterinary medicines docid\ uuchsu 9cxggi8oounag actions that veterinarians must take when using or authorising restricted veterinary medicines comply with the requirements and expectations of the mpi in relation to authorisation this is set out in mpi’s published acvm notice requirements for authorising veterinarians dated 28 august 2015 comply with all points in sections 1 and 2 of the veterinary medicines section of this code only authorise rvms following a veterinary consultation, or issuing voi as detailed in section 4 only authorise pms or controlled drugs following a veterinary consultation honour requests that ask for written authorisations instead of dispensing decide, when authorising rvms and pms, the most appropriate period of supply for each product authorised after considering the maximum periods of supply the following maximum periods of supply apply for authorisations 3 months for pms 6 months for rvms for companion animals other than horses 4 months for critically important antibiotics 12 months for all other rvms for production animals and horses within the above limits, the actual period of supply chosen will depend on the particular rvm/pm, the condition being treated, and the risks that need to be managed here we see that for pms e g gabapentin, the maximum period of supply is 3 months and for new authorisation following this there must be a veterinary consultation what a veterinary consultation comprises of will be covered in the second part of this advice for controlled drugs, the requirements around supplying controlled drugs were amended in december 2022 the relevant part of the misuse of drugs regulations (“the regulations”) is cl 31(1) (a) (d) which set out that a person may not supply a controlled drug more than once on that same prescription, or in a quantity that is greater than a quantity sufficient for a use of a period of one month so, the maximum period of supply for controlled drugs (for example, phenobarbitone) is one month with no repeats what is a veterinary consultation? do i have to physically examine the patient every time i authorise more medication after the maximum period of supply (so after three months for pms and one month for controlled drugs, including phenobarbitone)? a veterinary consultation is defined in the code here veterinary consultation a veterinary consultation must include the veterinarian interviewing the client (or a legitimate and authorised representative of the client) collecting and recording sufficient information relevant to the individual circumstances to ensure the proposed course of action (including treatment) is appropriate to meet the needs and best interests of the animal(s) and the client obtaining appropriate consent to the proposed course of action being given, and accepting responsibility for, the ongoing health and welfare of the animal(s) concerned in relation to the consultation this includes arranging emergency care after considering the circumstances and the potential for adverse effects from, or failure of, the agreed course of action determining and providing the appropriate level of advice and training so as to be satisfied that the agreed course of action can proceed as planned a veterinary consultation will usually involve the veterinarian seeing the animal(s) at the time of the consultation if not, the animals must have been seen recently or often enough for the veterinarian to have sufficient personal knowledge of the condition/health status of the animal(s) this consultation is required in order for the veterinarian to be able to propose the particular course of action in regards to seeing the animal as in the consultation as defined above, what is recently or often enough? veterinarians are expected to use their professional judgement in determining this in each individual case when deciding whether the animal has been seen recently or often enough to authorise further medication without an in person examination, many factors must be considered some of which are included here time since initial diagnosis any changes in the medication or treatment plan the animal's medical history and stability of their condition any risk factors that need to be managed recent laboratory results or monitoring data presence of co morbidities or complicating factors owner factors, such as their ability to monitor, observe, and comply with treatment recommendations age and breed of the animal should i document this? veterinarians should document their decision in the clinical record, including the factors considered and whether a re examination is required summary the maximum period of supply for pms is 3 months and for controlled drugs is 1 month the actual amount authorised and dispensed each time will be decided by the authorising veterinarian taking into account any risk factors that need to be managed (up to the maximum amount) a new authorisation must then be made which includes a veterinary consultation a veterinary consultation includes the veterinarian seeing the animal or have seen the animal recently or often enough for the veterinarian to have sufficient personal knowledge of the condition/health status of the animal all relevant factors (risk, clinical, owner, medication history) must be considered when deciding if the animal(s) need to be seen in person the rationale for the chosen period of supply and the nature of the consultation (in person, phone, or video) should be documented if in doubt, err on the side of caution and arrange to see the animal in person regularly review your practice’s protocols for authorising and dispensing controlled drugs and pms to ensure they remain up to date with current regulations and standards