Supporting Seafarer Health: Managing Controlled Drugs Onboard

Welcome to our latest blog, which follows on from last month's look at medical compliance onboard, with advice on what constitutes a Controlled Drug - why it matters, what it means onboard, and some practical steps for managing stock. Plus some common mistakes in managing Controlled Drugs onboard and what happens if you get it wrong.

It's important to understand why and how to manage CDs onboard

Managing Controlled Drugs (CDs) onboard vessels is often viewed as a veritable minefield and it’s important to start by saying that no one is trying to get it wrong! But, the management of medications, and particularly Controlled Drugs, can be easily misunderstood or misinterpreted. 

Cases where CDs and other medications have been stored or disposed of incorrectly may be purely due to the person in charge not understanding the requirements, and not knowing where to go to find out the information they need. But getting it wrong can have severe consequences and lead to fines and even imprisonment.

It’s also important to check what medications can be supplied in which countries, and which are banned. For instance, a number of common prescription medications including codeine, diazepam, gabapentin, tramadol and zopiclone are banned in some Middle Eastern and other countries. 

This could cause supply issues meaning a vessel would not be able to receive a restock of some medications in those locations. Forward planning would be essential to order well in advance for delivery to a country where it is permitted.

Plus, anyone joining the vessel and carrying their own medications will need to check on requirements prior to travelling. The NaTHNaC website, recommended by the UK Government, is a good source of information for travellers.

In UK law, the Medicines Act (1968) is the legislation that governs manufacture and supply of drugs while the Misuse of Drugs Act (1985) defines activities relating to the control, supply and possession of CDs. 

Regulations are directives from an authority with the force of law. The Human Medicines Regulations (2012) consolidates UK law relating to human use of medicinal products, while the Misuse of Drugs Regulations (2001) defines activities relating to the control, supply and possession of CDs, and the Hazardous Waste Regulations (2005) detail requirements for the control and tracking of hazardous waste.

The Medicines Act (1968) splits medications into 3 categories:

• GSL - General Sales List - available over the counter

• P - Pharmacy - available from a pharmacy or pharmacist

• POM - Prescription only medication - available from a prescriber. But with an exemption for those trained for the immediate, necessary treatment of someone who is sick or injured, without need for a prescription

Depending on the category of vessel, it’s likely that you will be carrying a number of POMs onboard. So it’s important to know that incorrect handling of POMs is an offence. This means it’s really important that anyone dealing with medicines onboard works within their scope of practice - in simple terms, just do what you’re trained to do.

Morphine is a Class A, Schedule II Controlled Drug

All drugs, including those used for medication purposes, are given a Classification and a Schedule. Classes are based on how dangerous a drug is and Class A denotes the most dangerous, but a drug can move up and down classifications over time.

• Class A includes cocaine, ecstasy, heroin, LSD, magic mushrooms, crystal meth, morphine

• Cass B includes amphetamines, barbiturates cannabis, codeine, GHB, GBL, ketamine, methylphenidate

• Class C includes tranquilizers - clonazepam, diazepam, hydrocodone, mescaline and hallucinogenic substances.

Schedules reflect the different restrictions to prescription drugs and monitoring of Controlled Drugs. Schedule 1 has tightest controls.

• Schedule I drugs have no therapeutic value and include opium (heroin), cannabis, LSD, ecstasy. These can’t lawfully be possessed or prescribed and a Home Office licence is required for production and possession.

• Schedule II means there is a high potential for abuse and includes morphine, cocaine, diamorphine, methadone, fentanyl, oxycodone.

• Schedule III means there is a moderate/low potential for abuse/dependence and includes barbiturates, buprenorphine, gabapentin, midazolam, pregabalin, temazepam, tramadol and others.

• Schedule IV means a low potential for abuse/dependence and common medications include Xanax and valium.

• Schedule V means a low potential for abuse/dependence. Including antidiarrhoeal, antitussive (for coughs), analgesic and other over the counter medications.

With all of this information behind our medications, it’s no wonder that confusion and misunderstanding can happen. Good practice when handling medications includes following the National Institute of Clinical Excellence (NICE) guideline and double checking the following before administering any medications:

• Right patient

• Right medicine

• Right route

• Right dose

• Right time

• Right to decline

Record keeping is essential to patient safety and remember, if it’s not written down, it didn’t happen!

You will need to keep a record of the patient's presentation, your examination and findings, vital signs, signs and symptoms, actions and treatment. The SAMPLE history can be useful to follow to ensure nothing is missed out and the ATMIST handover tool for trauma can be easily adapted for medical issues too. Additionally, if you note any side effects or adverse effects, they will need to be part of your records and handover.

Storing Medications

If you subscribe to a medical service, you will most likely be provided with software to help manage your stocks, and resupplies of used or expired stock may be automatic. If not, even a simple spreadsheet can help, and here’s a few pointers:

• All medications onboard, from CDs to over the counter, need to be stored securely.

• All administration of medications must be logged and accounted for, including batch numbers in case of any issues. This helps to manage stock and may show trends in usage.

• Expiry dates must be checked and recorded regularly - this is important to help manage stock. 

• Out of date/expired or spoiled stock must be removed and disposed of, with records updated accordingly.

• Disposal of medications must be carried out appropriately - prescription and OTC can be taken to a pharmacy, GP surgery or walk in centre to hand over for destruction.

Controlled Drugs

In addition to the above points:

• CDs must be stored behind two locks with restricted access. So inside a locked safe, in a locked cupboard or room, with limited keyholders is appropriate.

• All CD stock and usage must be recorded in a drugs book.

• Disposal of CDs must follow guidelines and you need to record disposal in the drugs book.

• Any unused part doses of CDs must be stored in a ‘DOOP’ jar and recorded. This is a denaturing container that makes the CD unusable, preventing it from being misused or entering the environment. 

Finally, we’d like to reiterate that if you’re not sure about something related to handling, storing and administering medications, including CDs, please speak to your supplier as they will be happy to help. Or, if you’d like Red Square Medical to carry out an audit onboard, please contact us using this form.