What guidelines should I follow for prescribing controlled substances in primary care?

When prescribing controlled substances in primary care, follow these key guidelines to ensure safe and effective use:

• Document clearly the indication and regimen for the controlled drug in the patient's care record, including dosage instructions and maximum daily amounts for 'when required' medications.
• Assess clinical needs regularly and adjust doses to balance benefits and harms, considering all prescribed and non-prescribed medicines the patient is taking, especially centrally acting agents.
• Limit prescriptions to a supply that meets clinical needs for no more than 30 days, documenting reasons if a larger quantity is prescribed.
• Use recognised opioid dose conversion guides when prescribing, reviewing, or changing opioid prescriptions to consider total opioid load.
• Discuss treatment plans and monitoring arrangements with the patient, including information on how long the drug is expected to be used, how it works, its purpose, and effects on activities such as driving.
• Advise patients on safe disposal of unwanted or used controlled drugs at community pharmacies.
• Follow local or national guidelines for prescribing, reviewing, and changing controlled drug prescriptions, documenting any deviations and reasons.
• When prescribing repeat prescriptions for long-term conditions, determine review frequency based on the drug and individual circumstances.
• Ensure confidentiality and share prescribing information appropriately with other healthcare professionals, especially when controlled drugs are prescribed outside general practice.

These practices align with NICE guidance on controlled drugs and safe prescribing to minimise risks such as dependency, overdose, and diversion, while supporting patient involvement in decision-making.

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