As a general practitioner in his 25th year of practice, including on call (mainly in a local two-practice rota but sometimes for a deputising service), I decided to audit my controlled drugs register (CDR). The study period was from September 1979 to January 2003, a total of 244 months. Recorded diagnoses reflect a practical approach to patients seen and managed as emergencies in a primary care setting.
The total number of patients requiring a controlled drug was 325, and approximately 38 different conditions within seven categories were recorded (Table 1). Drugs used were diamorphine injection (n = 177), pethidine injection (140), and morphine sulphate tablets (8).
Table 1 Number of patients requiring controlled drugs, by diagnostic category.
A CDR does not record outcome or further management strategies (for example, hospital admission). Good communication and follow-up are clearly essential for any patient requiring this level of analgesia. A visiting doctor carrying a bag containing drugs also raises the issue of personal safety. In 25 years I have been cautious and probably lucky.
While home visits have become less popular, more patients are discharged early from hospital and there is a greater emphasis on ‘packages’ of care, enabling patients to remain at home for longer. The new GP contract may finally free many GPs from an on call commitment, however, the range of medical problems, their severity, and diurnal pattern of presentation will not simply go away. This creates another dilemma in adequately training our future registrars.
There is a paucity of published information on the emergency administration of controlled drugs in primary care. In the aftermath of the Shipman affair, some GPs may decide not to carry opioids. This small study suggests that the overall frequency of use is relatively small (approximately 10 times per year) but may be desirable; for example, when analgesic problems occur in cancer patients who are dying at home.
From laudanum (tincture of opium) to the 21st century, will future GPs continue to carry controlled drugs?
- © British Journal of General Practice, 2004.
