Controlled drugs in care homes

Page last updated: 9 July 2024

Schedule 2

Unless a person is looking after their own medicines, you must store Schedule 2 drugs in a controlled drugs cupboard. Keep records of these drugs in your controlled drugs register. Examples include:

morphine
diamorphine
methadone
fentanyl
alfentanil
oxycodone
methylphenidate
dexamphetamine
lisdexamfetamine
ketamine
tapentadol.

Some services may choose to store controlled drugs from other Schedules in the controlled drugs cupboard and record them in the controlled drugs register. You should always follow your service’s medicines policy.

Schedule 3

You do not need to record Schedule 3 drugs in the controlled drugs register. However, you must store certain Schedule 3 drugs in the controlled drugs cupboard. This includes, for example, buprenorphine and temazepam.

Some other Schedule 3 drugs do not need to be stored in the controlled drugs cupboard. Examples include:

midazolam
pregabalin
gabapentin
tramadol
barbiturates (phenobarbitone).

Other schedules

You do not need to store controlled drugs in Schedules 4 and 5 in the controlled drugs cupboard or record them in your controlled drugs register. However, you must consider where you store these drugs and ensure they are stored securely.

You must keep accurate records of their receipt, administration, and disposal to minimise the opportunity for diversion. Examples include:

morphine sulfate solution (Oramorph®) 10mg/5mL
zopiclone
codeine
benzodiazepines (for example, diazepam, lorazepam and clonazepam).

Policies and procedures

You must have a policy or standard operating procedure that details how you manage controlled drugs in your service. This should cover:

ordering
storing
administering
recording
disposal.

It should include what to do if there's a discrepancy and the contact details of anyone who you need to inform. This should include the regional NHS controlled drugs accountable officer (CDAO) at NHS England or the police, depending on the circumstances. Check that you have the correct contact details for:

the relevant controlled drugs accountable officer (CDAO) on our website: Controlled drug accountable officers
your regional NHS England CDAO
your nearest police controlled drugs liaison officer (CDLO).

You also need to inform CQC if the incident meets the criteria of a statutory notification.

Incidents involving controlled drugs should be reported to your local CDAO. You can do this on the CD reporting website using this link. If you need further information or support with managing controlled drugs or reporting incidents, you can contact your regional NHS England CDAO.

Controlled drug registers

You must record any movement of a Schedule 2 controlled drug in a controlled drugs register. The register should be a bound book with numbered pages.

You must use the register to record the receipt, administration, disposal and transfer of controlled drugs held by the care home.

The following are important points:

The entry must be made as soon as possible on the same day.
Entries must be in chronological order.
Entries should be legible and not be cancelled, altered, or crossed out. You should sign and date any corrections in the margin or in footnotes.
The member of staff making the entry should sign and date it. Whenever possible, all entries should also be witnessed by a suitably trained member of care home staff who should also sign the entry.
The register should not be used for any other purpose.
The register must be kept in a secure place when not in use.

Where controlled drugs are prescribed and dispensed for an individual person, you should:

enter the person’s name, the name of the controlled drug, its form and strength at the top of the page
use a separate page for each form and strength of medication.

Electronic registers are permitted as an alternative to a hard copy book.

Legislation requires that digital entries must:

be attributable to the person who created the record
be secure
be able to be audited, including any corrections that have been made
comply with best practice
be accessible from the care home and able to be printed.

You should also record these details in a medicines administration record:

the name of the person given the controlled drug
the dose and time administered.

Holding stocks of controlled drugs

Care homes with nursing can hold stocks of controlled drugs. The register must have a separate section for each different controlled drug and there should be a separate page for each formulation and strength. Enter the name, form, and strength at the top of the page.

To meet people’s clinical needs, care homes with nursing can hold stocks of controlled drugs in Schedules 3, 4 and 5 without the need to have a Home Office licence. For example, if several people are receiving care at the end of life. However, you may need a controlled drugs licence to hold stocks of controlled drugs in Schedule 2. See the Home Office website for more information.

Care homes without nursing must not hold stocks of controlled drugs. They can only hold controlled drugs prescribed and dispensed for an individual person.

You can ask for advice on Home Office legislation by contacting the Home Office Duty Compliance Officer.

Managing controlled drugs

Care homes need to keep a running balance of the stock levels of each controlled drug preparation. This makes it much easier to spot and track discrepancies.

It is good practice for 2 members of staff to witness and sign when:

a care home receives controlled drugs stock
checking stock balances
administering controlled drugs
disposing of controlled drugs.

Both members of staff involved in the process should be trained and competent to do this.

You need to keep detailed records when administering topical controlled drugs, for example transdermal patches. These records should include the site of application and the frequency of rotation of the site.

Prescriptions for controlled drugs are valid for 28 days after the date on the prescription. The Department of Health and Social Care strongly recommends that the maximum quantity of controlled drugs prescribed should not exceed a period of 30 days.

There must be a valid controlled drugs prescription to obtain supplies from a pharmacy. Staff must make sure ordering processes are robust enough so that people do not run out of these medicines.

Storing controlled drugs

Controlled drugs cupboards must meet British Standard BS2881:1989 security level 1 and the requirements of The Misuse of Drugs (Safe Custody) Regulations 1973 (legislation.gov.uk).

You do not need to store the controlled drugs cupboard within another cupboard.
You must not use the controlled drugs cupboard to store other items such as jewellery or money.
You must restrict access to the cupboard according to need.
Store spare keys securely.
There are no rules about which members of staff can hold controlled drugs keys in a care home. Providers should carry out a risk assessment to decide this. This should also be included in your controlled drugs policy.
If a person is self-administering controlled drugs, they can keep them in their possession provided the controlled drugs are kept safely. A risk assessment should consider where the controlled drugs will be stored.

Refrigerating controlled drugs

If a controlled drug has safe custody requirements and needs to be kept in a fridge, it will need to be stored in a locked medicines fridge.

There are no medicines fridges available (that we know of) that meet the Misuse of Drugs (Safe Custody) Regulations. Therefore, controlled drugs subject to the safe custody requirements that require refrigeration can be stored in a standard locked medicine fridge.

You can store other medicines in the same medicine fridge as controlled drugs, but they must be stored separately. To provide additional security, controlled drugs should be kept in a lockable box within the fridge and access should be restricted.

Disposing of controlled drugs

You should separate unwanted or out-of-date controlled drugs from current stock and store in line with your policy. In care homes without nursing, store them in the controlled drugs cupboard until they are returned to the community pharmacy for destruction.

Make a record in the controlled drugs register. This should be signed by the person making the entry and another suitably trained person as a witness.

Care homes without nursing

All medicines, including controlled drugs, must be promptly returned to a community pharmacy. Pharmacies are contractually obliged to dispose of medicines waste for care homes without nursing and you do not require a T28 waste exemption as the pharmacy will denature the controlled drugs.

Good practice involves one member of staff to make the record of controlled drug destruction in the controlled drugs register and a second member of staff to check and sign the record. This helps to verify that the register is accurate. Make sure to record the new stock balance. Some pharmacists will sign the register to acknowledge receipt. This is not a legal requirement.

Care homes with nursing – people's own controlled drugs

People’s own individually labelled controlled drugs (Schedules 2, 3 and 4 (Part I)) must be denatured before handing to the waste disposal company. The Environment Agency classes this as processing waste. Care homes with nursing will need to apply for a T28 waste exemption. This is free of charge.

Good practice involves one member of staff to make the record of controlled drug destruction in the controlled drugs register and a second member of staff to act as a witness and check and sign the record. Make sure to record the new stock balance.

Care homes with nursing - stock controlled drugs

You must denature out-of-date stocks of controlled drugs in Schedules 2, 3 and 4 (Part I) before handing to the waste disposal company.

You must destroy Schedule 2 stock in the presence of an authorised witness. This includes a police constable or inspectors of the General Pharmaceutical Council. The lead NHS England controlled drugs accountable officer may also appoint authorised witnesses.

You also need to record details of the destruction in your controlled drugs register. It is good practice for another member of staff to witness the denaturing of stock in Schedules 3 and 4 (Part I).

Medicinal and food grade cannabis products

Cannabis-based products for medicinal use (CBPMs) are Schedule 2 controlled drugs. They can only be prescribed by or under the direction of a specialist doctor (through a shared care agreement) who must have specialist knowledge and expertise. The specialist doctor must be on the specialist register of the General Medical Council.

People can buy food grade cannabis products over the counter (for example, cannabidiol, CBD and hemp oil products) as food supplements. These products are not medicines and therefore cannot make health claims.

As with other over-the-counter products, care home staff should take medical advice if people want to use food grade cannabis products. This is in case there are any issues, for example, interactions with prescribed medicines.

A GP would not usually have to authorise the use of food grade cannabis products. But if a GP is involved, this could reduce any risks to the person concerned.

If people bring in food grade cannabis products for their own (or a relative's) use, the service must do its own risk assessment.

Supply of medicines for end of life care

NHS England advises that care homes should not routinely hold anticipatory medicines stock.

Access to medicines for end of life care varies locally. Commissioners may make local arrangements for medicines to be readily available when needed. This could be from a community pharmacy, GP practice, hospital, or other settings.

NHS England publishes a regular bulletin. It provides updates for teams across general practice, dentistry, community pharmacy and optometry.