Bureaucracy is preventing timely and adequate access to controlled drugs during the pandemic, says Ian Hamilton
Imagine knowing how to help patients with covid-19 who are in pain or experiencing severe shortness of breath, but being unable to intervene due to bureaucracy. This is becoming a familiar situation to prescribers and pharmacists during this pandemic, as they are unable to use controlled drugs like morphine to help patients in a timely way.
Rules designed before covid-19 are causing delays and leading to waste. For example, morphine can only be prescribed and dispensed to a named patient. Consequently, if some is left over this has to be disposed of rather than used for another patient. In some areas there are shortages of these drugs, making their wastage particularly frustrating for staff. So concerned about this is the Royal College of General Practitioners that they wrote to the home secretary, Priti Patel, last week to request a loosening of the regulations.
The home secretary is aware of this issue as she had asked her scientific advisers a month ago for their thoughts on this. The Advisory Council on the Misuse of Drugs are known to be cautious in their views on matters like this, however they recommended changes to the regulations on controlled drugs—albeit with some caveats. It is one of these caveats that the Home Secretary is waiting for before enacting these changes in legislation. The recommendation that there should be guidelines in place before the new regulations are introduced makes sense. It will help to ensure that prescribers, pharmacists, and carers understand what will be permitted and the practicalities of how and when these changes can be used.
I provide expert advice to the Royal College of Nursing on drugs and addiction, and at the time of writing, I along with experts from other royal colleges are still waiting to be contacted about drafting or commenting on these guidelines.
The government and its advisers are rightly concerned about the risks that these proposed changes to the regulations could have—for example, the risk that these drugs could be diverted into the black market or misused in some other way. As with all medicine, the regulatory decision must be made on a risk-benefit calculation. Yet these risks highlighted by the Home Office seem minor when compared with the risks of not making changes to the rules. Being in pain or having severe shortness of breath will delay recovery, or worse could even elevate the risk of coronary or respiratory problems. For patients who have no chance of recovery, it could mean dying in unnecessary pain, which will be traumatic for patients and staff.
Controlled drugs like morphine are rarely viewed in a neutral way: most people, including politicians, will have some preconceptions about them. This could include a fear that patients will become dependent on opiates. This is understandable but unlikely in this specific instance given that patients would only be exposed to these medicines during the acute phase of their covid-19 infection.
Equally, there could be a fear among politicians and others that this is euthanasia by the back door. Again this is unjustified as the proposed changes won’t abandon all the checks and balances on when and how these drugs are prescribed and dispensed.
The government has repeatedly said that it is willing to be guided by the science in its response to the covid-19 pandemic. Ensuring timely access to controlled drugs is underpinned by the science, but it is for politicians to decide how the evidence is implemented. To their credit, the Home Office has listened to those calling for regulatory change and is working towards this, however until there is clear legislation and prescribers, pharmacists, and carers are given guidance on how to implement these changes, we are in limbo. Every day that bureaucracy prevents timely and adequate medication for these patients, the risk of unnecessary suffering continues.
Ian Hamilton is an academic at the University of York with an interest in addiction and mental health. He previously worked as a mental health nurse with people who had combined mental health and substance use problems. Twitter: @ian_hamilton_
Competing interests: I am affiliated with Alcohol Research UK.