Misuse of Drugs (Jersey) Law 1978: Proposed amendments

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A decision made on 28 October 2013:

Decision Reference: MD-HSS-2013-0045
Decision Summary Title :	Misuse of Drugs (Jersey) Law 1978 - Various amendments regarding the classification and control of substances		Date of Decision Summary:	21st October 2013
Decision Summary Author:	Chief Pharmacist		Decision Summary: Public or Exempt? (State clauses from Code of Practice booklet)	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:
Written Report Title :	Misuse of Drugs (Jersey) Law 1978 - Various amendments regarding the classification and control of substances		Date of Written Report:	21st October 2013
Written Report Author:	Chief Pharmacist		Written Report : Public or Exempt? (State clauses from Code of Practice booklet)	Public
Subject: Misuse of Drugs (Jersey) Law 1978 - Various amendments regarding the classification and control of substances
Decision(s): The Minister endorsed the recommendations of the Misuse of Drugs Advisory Council and accordingly determined that amendments to the Misuse of Drugs (Jersey) Law 1978, as amended, should be prepared.
Reason(s) for Decision: The Misuse of Drugs Advisory Council has recommended that substances be classified or reclassified as controlled drugs under the provisions of the Misuse of Drugs (Jersey) Law 1978; that non-medical prescribers be permitted to prescribe controlled drugs; that a requirement for licensing in order to prescribe buprenorphine for the management of addiction be introduced and that provisions to automatically recognise UK Temporary Class Drug Orders be introduced.
Resource Implications: None
Action required: The Law Draftsman to be requested to prepare the necessary amendment on the basis of a drafting brief to be provided by the Chief Pharmacist.
Signature:		Position: Minister for Health and Social Services
Date Signed:		Date of Decision (If different from Date Signed):

Misuse of Drugs (Jersey) Law 1978: Proposed amendments

STATES OF JERSEY

HEALTH AND SOCIAL SERVICES DEPARTMENT

Misuse of Drugs (Jersey) Law 1978

Various amendments regarding the classification and control of substances

Issue

The Minister is requested to consider bring a range of substances under the control, or further control, of the Misuse of Drugs (Jersey) Law 1978 and to consider various other amendments to the Misuse of Drugs (Jersey) Law 1978 as outlined below.

Introduction

The Misuse of Drugs Advisory Council (MDAC) is established in accordance with Article 2 of the Misuse of Drugs (Jersey) Law 1978 and has a duty to advise the Minister on measures, which in its opinion, should be taken to prevent the misuse of drugs and/or to deal with the social problems connected with drug abuse.

Substances recommended for control under the Misuse of Drugs (Jersey) Law 1978

The MDAC has given consideration to proposals to bring a range of substances under the control, or further control, of the misuse of drugs legislation due to their potential to cause harm. The specific substances are as follows:

3.1. Tramadol

Tramadol is a synthetic opioid with effects similar to those of codeine. It is an analgesic of significant medical use and has wide ranging applications mostly in the treatment of moderate to severe pain and including the treatment of fibromyalgia (wide spread chronic pain), cancer pain and moderate to severe musculoskeletal pain. In a similar way to other psychoactive agents of the opioid class, it can be liable to misuse.

Tramadol has a unique dual-action pharmacological profile that increases the risk of adverse effects seen in overdose. The symptoms of tramadol overdose include rapid heartbeat, high blood pressure, vomiting and seizures. Tramadol overdose can cause serotonin syndrome, which is potentially fatal. Treatment of tramadol overdose with Naloxone only reverses the opioid effects, therefore, it is more likely to cause harm than other opioids, especially when combined with other monoamine-active drugs e.g. ecstasy.

The UK Advisory Council on the Misuse of Drugs has recently undertaken a review of the harms associated with the non-medicinal use of tramadol. This review was prompted by an increasing number of reports of tramadol’s misuse and harms. The UK Advisory Council’s review of the evidence raised concerns, particularly the increase in tramadol related deaths in recent years. Consequently the UK Advisory Council considered the harms associated with tramadol to be commensurate with other Class C drugs and recommended that tramadol be classified as a Class C substance.

The MDAC has considered the UK Advisory Council’s recommendation and has concluded that tramadol be similarly controlled in Jersey. The MDAC therefore recommends that tramadol be controlled as a Class C substance under the Misuse of Drugs (Jersey) Law 1978 and placed in Schedule 3 to the Misuse of Drugs (General Provisions) (Jersey) Order 2009.

3.2. Amphetamine

Amphetamine is currently controlled as a Class B substance under the Misuse of Drugs (Jersey) Law 1978 and is placed in Schedule 1 to the Misuse of Drugs (General Provisions) (Jersey) Order 2009 and in Part 1 of the Schedule to the Misuse of Drugs (Designation) (Jersey) Order 1989.

Substances are normally only placed in Schedule 1 to the General Provisions Order, and in Part 1 of the Schedule to the Designation Order, when they have no recognised medical use. As amphetamine has recognised medical uses the MDAC recommend that it be placed in Schedule 2 to the Misuse of Drugs (General Provisions) (Jersey) Order 2009 and removed from Part 1 of the Schedule to the Misuse of Drugs (Designation) (Jersey) Order 1989.

Non-Medical prescribing of Controlled drugs

4.1. Recent amendments to the Medicines (Jersey) Law 1995 have established a legal basis for non-medical prescribing with, in the first instance, certain categories of nurses and midwives being recognised as authorised practitioners in relation to the issuing of a prescription authorising the supply and/or administration of prescription only medicines. It is intended that pharmacists, who have undertaken the necessary additional training and who meet the necessary governance arrangements, will also be recognised as authorised practitioners in due course subject any necessary legislative amendments.

The MDAC recommends that the Misuse of Drugs (Jersey) Law 1978, and subordinate legislation, be amended to allow the non-medical prescribing of controlled drugs. This is consistent with the situation in the UK where nurse independent prescribers and pharmacist independent prescribers may prescribe controlled drugs. In the first instance this will be for nurse independent prescribers but should also include pharmacist independent prescribers as and when amendments to the Medicines (Jersey) Law 1995 permit.

The MDAC recommends that non-medical prescribers be able to prescribe, possess, supply, offer to supply, administer and give directions for the administration of any controlled drug in Schedules 2 to 5 of the Misuse of Drugs (General Provisions) (Jersey) Order 2009. Furthermore, the MDAC recommends that non-medical prescribers be able to compound any drug specified in Schedules 2 to 5 of the Misuse of Drugs (General Provisions) (Jersey) Order 2009 and that other persons may also compound drugs specified in Schedules 2 to 5 when acting in accordance with the written directions of a non-medical prescriber.

Amendments to the Misuse of Drugs (Addicts) (Jersey) Order 1980.

5.1. Buprenorphine

Buprenorphine is a Class B controlled drug listed in Schedule 2 to the Misuse of Drugs (General Provisions) (Jersey) Order 2009. It is a strong opioid used for the management of severe pain and also in the management of opioid addiction as part of a structured substance misuse programme.

Unlike methadone, no licence is required to prescribe buprenorphine for the purposes of managing addiction to opioids. Methadone is specified in Article 3(3) of the Misuse of Drugs (Addicts) (Jersey) Order 1980 such that only doctors who are licensed may prescribe methadone for the management of addiction.

The MDAC recommend that buprenorphine be added to the Misuse of Drugs (Addicts) (Jersey) Order 1980 so that a licence is required by prescribers in order to prescribe buprenorphine for the management of addiction. Buprenorphine should also be added to the list of substances specified in the Schedule to the Misuse of Drugs (Addicts) (Jersey) Order 1980. The prescription of buprenorphine for organic disease or injury, (e.g. for the treatment of pain) is not affected by this and may continue without the requirement for a license.

5.2. Licensing of Non-Medical Prescribers

In conjunction with the recommendation of the MDAC described in 4.1 above the MDAC also recommend that the Misuse of Drugs (Addicts) (Jersey) Order 1980 be amended to provide for the licensing of non-medical prescribers such that they may prescribe both methadone and buprenorphine for the purposes of managing opioid addiction. In the first instance this will be nurse independent prescribers but should also include pharmacist independent prescribers once they are recognised as authorised practitioners for the purposes of issuing a prescription for a prescription only medicine under the Medicines (Jersey) Law 1995.

Temporary Class Drug Orders

The UK has introduced a fast track legislative framework which allows for the rapid control of new and emerging substances which the UK Advisory Council on the Misuse of Drugs considers to pose a significant risk of harm. Temporary Class Drug Orders have been used to impose temporary restrictions on so called legal highs while a comprehensive evaluation of the evidence is undertaken. Following a review of the available evidence the relevant substance(s) are either formally controlled under the existing provisions of misuse of drugs legislation or not controlled where the evidence indicates no potential to cause harm.

The MDAC recommends that the Misuse of Drugs (Jersey) Law be amended to automatically recognise a Temporary Class Drug Order made in the UK with the same offences and penalties applying in Jersey as they would in the UK.

The Temporary Class Drug Order should remain in effect in Jersey until it is revoked by the Minister as a consequence of either controlling the relevant substance(s) under the existing provisions of the Misuse of Drugs (Jersey) Law 1978 or removing all controls on the relevant substance(s). In either case this should only occur following a recommendation from the MDAC.

Recommendation

The Minister is requested to approve the recommendations of the Misuse of Drugs Advisory Council as described above and direct the Chief Pharmacist to prepare a brief for consideration by the Law Draftsman.