DISPENSING OF

NARCOTICS AND
CONTROLLED
DRUGS

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 Introduction
 Drugs are beneficial to the mankind, some of them
are harmful if they are not used properly and misused
because of their peculiar properties.

 Example of such substances are, Morphine, and allied

alkaloids of opium, cocaine, etc..

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 CONTROLLED DRUGS
1. NARCOTICS (Painkillers or opioids) analgesics)
Codeine 
Oxycodone 
Hydrocodone 
Fentanyl -- available as a patch 
Morphine 
Hydromorphone 
Meperidine 
Pethidine 
Tramadol 
2. Benzodiazepine
Diazepam, Clonazpam, alprazolam, temazepam, Midazolam 
3. Barbiturates
Phenobarbitone, secobarbital, pentabarbital 
 Why handling narcotic drugs are controlled
and strict?
Due to potential risk of drug abuse, dependence, tolerance abuse and addiction 

Note
Physical dependence: altered physiological state due to prolonged administration of 
substance which upon cessation can result in withdrawal symptoms.

Psychological dependence is a form of dependence that involves emotional 

motivational withdrawal symptoms as anxiety 

Substance withdrawal means physiological & psychological symptoms result from stopping 
of substance that has been used for long time

Tolerance means the need to regularly increase the dose of drug or substance to obtain the 
same effect. It is usually a part of addiction.

Drug abuse is use of drug by self administration in a manner deviated from approved 
medical pattern leading to social, occupational & health problems. Drug abuse can lead to
drug dependence or addiction

Drug addiction is the compulsive use of a substance, despite its negative or dangerous 
effects.
 Hospital control procedures
 Responsibility for controlled substances in the hospital are
strict and it is necessary also.

1. The hospital director is responsible for:

 Proper safeguarding.

2. Pharmacist Responsibility for the:

 Purchase. The chief pharmacist has to make purchase
order.
 Storage
 Accounting of such drugs

3. The head nurse of a nursing unit is responsible for the:

 Proper storage
 Use of the nursing unit’s controlled substances.
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 Storage and records
 Purchased Narcotic and controlled drug must be kept in a safe locker.

 Special documents for purchase

 Purchase are subjected to annual Editing.

 Daily dispensing records, ward supply, and ward floor stocks should be
entered and documented separately

 Empty Parenteral vial or ampoules account also maintained in a proper way.

 Every shift, staff must endorse the quantity of drugs and the dispensing
summary to the next shift.
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 All these procedures are done under the supervision of the chief pharmacist.
 Prescription or Doctors orders
 Doctors’ order must be written in the specialized prescription
 The prescription must have the following details:
 Name of the patient (three names).
 Age
 Sex
 Health file number
 Clinic or department
 Diagnosis.
 Drug name (generic). dose (metric), frequency and duration
 Prescriber’s name,
 Signature of prescriber with date and his stamp.
 There should not be any correction or over writing in the
prescription.

 At Time of drug administration,

 Name and signature of the nurse who administers the drug.
 Head nurse signature.
 There should not be any correction or over writing in the
prescription and medication order 7
 Telephone orders
 A doctor may order a controlled drug by telephone in
case of necessity.

 The nurse will :

 Write the order on the doctor’s order sheet
mentioning that it is a telephone order
 Write the doctor’s name
 Write her name.

 The controlled drugs may then be administered at

once.

 The order must then be completed, signed by doctor

with his signature within 24 hours.

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 Verbal orders
 A verbal order may be given in an extreme emergency
where time does not permit writing orders.

 The nurse will :

 Write the order on the doctor’s order sheet
mentioning that it is a verbal order
 Write the doctor’s name
 Write her name.

 The controlled drugs may then be administered at

once.

 The order must then be completed, signed by doctor

with his signature within 24 hours.

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 Dispensing controlled drugs for home
use when pharmacy is closed
 When patients are discharged & pharmacy is closed or those
who failed to come and take their due medication in day time.

 A prescription signed by the registered medical practitioner on

duty is required.

 The doctor will calculate the smallest amount of the drug

necessary to treat the patient until the pharmacy opens.

 Dr. will write the prescription for the least amount and the
nurse may dispense the medication from the floor stock supply
(only oral preparation not Parenteral).

 The next day the prescription will be submitted to the pharmacy

to replace the dispensed quantity in last night.

 Another new prescription of large quantity for the patient is

written when pharmacy is opened.
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 Procedures in Waste or accidental
breakage of narcotic substances

 The pharmacist/nurse record the amount carefully in the daily

narcotic administering record.

 When a complete dose not used, discard the remaining dose with a
pharmacist and the treating physician as the witness and record as
discarded with reason

 When a ampoule is accidentally broken. The incident should be

recorded and informed.

 The incident should be investigated and a final judgment will be

given and the net loss will be replaced from the pharmacy.

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 Procedures if drug expired
 Any controlled or narcotics drugs are expired it should be informed
to the regional medical supply stores

 Notify Before 6 months of expiration of the drug

 A destruction approval letter should be sent to the regional

headquarters with the six copies of the expiry notification done in
the region.

 The drugs must kept safe in a separate area in the pharmacy till
further notification about the destruction comes.

 The drugs are destructed upon approval from higher authorities.

 Destruction is performed by a assigned committee.

 The destruction report is documented as follows:

 Name of drug, batch number, quantity, etc.
 The report should be signed by the committee members.
 The committee members are Pharmacist, Physician, narcotic person
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(police), administrator.
Narcotic & controlled prescription

The prescriptions must be stored 

safely for three years.

After three years a destruction 

report should be made through the
committee appointed by the
hospital director.
Schedule I
Schedule I drugs, substances, or 
chemicals are defined as drugs with no
currently accepted medical use and a
high potential for abuse.

:Some examples of Schedule I drugs are 

Heroin o
Lysergic acid diethylamide (LSD) o
Marijuana (cannabis), o
Schedule II

Schedule II drugs, substances, or chemicals are defined as drugs 

with a high potential for abuse, with use potentially leading to
severe psychological or physical dependence.

:Some examples of Schedule II drugs are 

Combination products with less than 15 milligrams of hydrocodone o

per dosage unit
Methamphetamine o
Methadone o
Hydromorphone o
Meperidine o
Oxycodone o
Fentanyl o
Schedule III
Schedule III drugs, substances, or chemicals are defined as •
drugs with a moderate to low potential for physical and
psychological dependence.

Schedule III drugs abuse potential is less than Schedule I and •

Schedule II drugs but more than Schedule IV.

:Some examples of Schedule III drugs are •

Products containing less than 90 milligrams of codeine per dosage o

unit
Ketamine o
Anabolic steroids o
Testosterone o
Schedule IV

Schedule IV drugs, substances, or chemicals are defined as drugs 

with a low potential for abuse and low risk of dependence.

:Some examples of Schedule IV drugs are 

Xanax 

Valium 

Ativan 
Schedule V
Schedule V drugs, substances, or chemicals are defined as drugs •
with lower potential for abuse than Schedule IV

Schedule V consist of preparations containing limited quantities of •

certain narcotics.

Schedule V drugs are generally used as antidiarrheal, antitussive, •

and analgesic purposes.

:Some examples of Schedule V drugs are •

Cough preparations with less than 200 milligrams of codeine per •

100 milliliters

Lomotil •