Cluster page — medicines optimisation
Controlled drugs governance and opioid stewardship
Two halves of the discipline
Governance and stewardship — distinct but inseparable
Controlled drug work in primary care has two faces. The first is governance: the Misuse of Drugs Regulations compliance layer covering prescribing, storage, register-keeping, destruction and accountable officer reporting. The second is clinical stewardship: the proactive review of opioid and gabapentinoid prescribing to ensure appropriate use, dose optimisation, harm reduction and (where indicated) supported tapering.
Both have intensified through the 2020s in response to MHRA alerts on opioid-related deaths, the Faculty of Pain Medicine's evidence reviews on chronic non-cancer pain prescribing, and the 2019 reclassification of gabapentinoids. PCN clinical pharmacist teams own the operational delivery of both halves.
PCN CD workplan
What a PCN controlled drug programme covers
- CD register maintenance and quarterly audit per practice
- CDAO incident reporting route (loss, theft, supply chain anomaly)
- Opioid prescribing comparator (>120 mg MED daily patients identified)
- Structured opioid review in chronic non-cancer pain — SMR-integrated
- Gabapentinoid review — new starts, dose escalations, opioid co-prescription
- MHRA alert closure (opioid respiratory risk, addiction risk, prescription form changes)
- End-of-life anticipatory prescribing governance in care home cohort
Opioid stewardship KPIs
What good looks like
Frequently asked questions
Controlled drugs — FAQs
Who is the Controlled Drugs Accountable Officer?+
Every NHS England region appoints a CDAO responsible for oversight of CD management. ICBs and GP practices report CD-related concerns (loss, theft, supply chain anomaly, inappropriate prescribing pattern) to the CDAO via the agreed local route.
Which medicines are Schedule 2/3 controlled drugs in primary care?+
Most commonly: morphine, oxycodone, methadone, fentanyl, buprenorphine, diamorphine (Schedule 2); midazolam, temazepam, tramadol, gabapentin, pregabalin (Schedule 3). Each has specific prescription, storage and record-keeping requirements.
How do PCN clinical pharmacists support opioid stewardship?+
Through structured opioid review for patients on >120 mg morphine-equivalent daily, taper planning aligned to Faculty of Pain Medicine guidance, integration of opioid review into SMR for chronic non-cancer pain patients, and PCN-level prescribing comparator monitoring.
What about gabapentinoids?+
Reclassified Schedule 3 in 2019 following misuse and dependence concerns. PCN pharmacist teams run structured gabapentinoid review for new starts, dose escalations and long-term users, with particular focus on co-prescribing with opioids (additive respiratory depression risk per MHRA alert).
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