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GPs face tighter prescribing rules on tramadol and temazepam

GPs will need to observe tighter restrictions on the prescribing of tramadol and temazepam under Government plans to try to cut down on misuse of the drugs.

The changes will mean GPs will have to start providing written prescriptions for both tramadol and temazepam and will only be able to prescribe a month’s supply of the drugs at a time.

The restriction of tramadol prescribing comes after the Home Office accepted advice the drug should become controlled as a class C drug and placed in schedule 3 of the 2001 regulations on drugs misuse, following a spate of deaths linked to ‘recreational’ use.

The Government also plans to lift current exemptions on prescribing of the controlled drug temazepam, to bring it line with other schedule 3 drugs, because of ‘ongoing concerns’ around its misuse.

Following consultation on the proposals, however, the Home Office has accepted concerns from stakeholders including the Royal Pharmaceutical Society that ‘safe custody’ requirements for schedule 3 drugs would present problems for community and hospital pharmacies handling large volumes of tramadol prescriptions.

Dr Bill Beeby, deputy chair of the GPC’s clinical and prescribing subcommittee questioned how much impact the changes would have on tramadol over-dosing but said GPs would ‘accept the changes and work around them’.

Dr Beeby said: ‘There shouldn’t be any concern with normal prescribing – and I don’t know that controlled drug regulations greatly help with deaths from recreational use, but perhaps it does change the way it is supplied and people’s appreciation of these risks.’

Dr Beeby said GPs should be able to prescribe alternatives to temazepam.

He said: ‘There are other drugs that are perhaps less problematic, but all of these drugs should be considered carefully. The regulations and rules are there for a purpose – to draw attention to the fact this is a controlled drug to prescribers, and if the workload is onerous then consider using alternatives.’

Dr Richard West, chair of the Dispensing Doctors’ Association, questioned the rationale for the changes, which he said could mean a big increase in workload given controlled drugs cannot yet be prescribed electronically.

Dr West said: ‘We have concerns the proposals represent expensive over-regulation – we’re not sure the changes they propose will solve the perceived problem.’

He added: ‘The electronic prescription service doesn’t allow prescription of controlled drugs as it is currently set up, which will mean considerable work for practices because you have some prescriptions that can go one way and others that can’t - and the patients will not understand that change.’  

‘It will cause increased confusion and extra workload and therefore extra cost, but without clear evidence of what benefit there is.’

Outlining its decision, the Home Office stated: ‘The Government has taken on board the concerns raised in the consultation and has therefore decided to pursue [an alternative option] whereby tramadol is placed in Schedule 3 to the Regulations but with exemption from the safe custody requirements.’

On temazepam, the Home Office concluded: ‘The Government has considered the responses in the light of ongoing concerns around the misuse of temazepam, the fact that the vast majority of temazepam prescriptions are computer generated, evidence that prescribing of temazepam is currently at very low levels, and also in light of efforts to introduce electronic prescribing for Schedules 2 and 3 controlled drugs in the near future.’

‘The Government assesses that on the available evidence, the existing exemption for temazepam prescriptions are no longer warranted and should therefore be removed.’

Readers' comments (13)

  • Vinci Ho

    A significantly large number of patients with back pain, for instance , are using tramadol regularly. Right or not, the workload following can be substantial ....

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  • God we all have to kowtow to them! I,for one,am weary of them.

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  • This comment has been moderated.

  • Yet again they've got it wrong. Plenty of others that could have been picked. Diazepam is much more commonly abused, as is co-codamol. Why have they picked on these two?? Random or pharma influence?

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  • John Glasspool

    I am told that Pregabalin is the new "Temazepam". Let's ban that. Hasn't been around for long.

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  • Great - next pregabalin and gabapentin. None of these things should be on repeat except in exceptional cases

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  • A reduced supply can mean more visits to the GP!

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  • pregabalin is very expensive we can't prescribe that here without feeling dirty inside, ive given 1 patient it in 3 years (pain clinic recommendation)
    tramadol can be hard to avoid in the backpains in whom the 30/500's arent working well. the long term trams should move to morphine if theyre going to be on long term opiates otherwise tough - back to your para/cod. change the temazes to zop/amitrypt (unless theyre in their 80's and been on it since 1988)- if theyre not happy with that then again- tough

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  • I'm not a pain expert but I have been informed that the current mess regarding chronic pain management is that unfortunately our training has misled us into using principles designed for palliative care - which are not suited to chronic pain management. The pain control ladder was never intended to be used for chronic pain. We all have lots of patients on tramadol and pregabalin. Ask them how good the tablets are - the common response it that "they take the edge off the pain" or "I'm not sure what the pregabalin is for"! How often do we find the patient initially responding to our clever idea to swap one strong opiate for another only to find 2 months later they actually thought the first one as better after all? I think we need to be more honest with our chronic pain patients and tell them that we actually can't cure all the pain all the time.

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  • I require pain relief for rheumatoid arthritis. I can not tolerate NSAIDs. My GP prescribes DHC Continus, which acts over a 12 hr period and that is quite good.
    I did use buprenorphine patches during an acute flare up but have been told that I can't have them to manage regular pain levels. It's harder to abuse a TD patch than tablets, surely?

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  • Sorry, I hit return before finishing the comment.
    Tramadol is going to be tightly controlled yet DHC is not?
    And why, then, is it almost impossible to get TD opiate patches?

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