• Cancer Patients needs pain relief at all stages of their disease. Pain occurs in about one- third of patients receiving anticancer treatment. In these, pain relief measures and anticancer treatment go hand in hand. In patients with advanced disease, more than two-third experience pain and other symptoms become the main aim of treatment.
• The physiological basis of cancer pain includes a variety of mechanisms. The psychological aspects include anxiety, fear, depression and a sense of hopelessness. The aim of treatment is to relieve the pain to the patient’s satisfaction, so that patient can function effectively and eventfully die free of pain.
• Pain relief may be achieved by a variety of means. Treatment must be tailored to the individual, with drug treatment, radiation and anaesthetic, neurosurgical, psychological and behavioral approaches geared to the patient’s needs. Among this, drug treatment is the mainstay of cancer pain management.
• In India, narcotic drugs can be purchased, transported, stored and dispensed only after getting the license from the Food and Drug Administration under The Narcotic Drugs and Psychotropic Substances Act, 1985.
• The Narcotics should be issued by the Pharmacist on prescription from authorized doctors which mentions the following details: Date, Name of the patient, Age/sex, Drug Name and Strength of preparation n, Dose, Route
• The prescription should be duly signed and stamped by the prescribing doctor
• Three copies of prescription are must, one is returned back to Patient and One is required to submit in Drug Office on-demand and the last one for Pharmacy record is retained in the Narcotic Sales Record file – Bill and Prescription
• The pharmacist keeps a routine check of stocks for Physical available quantity and computer record, Expiry date, Stock out
• Patient’s signature is taken on the prescription.
• Narcotic drugs can be prescribed only by the anesthetists or consultants
• 3 copies are prepared for Narcotic drugs prescription
• One copy is for the patient, one copy is for pharmacy and last copy is for FDA(Submitted only when requested)
• Empty ampoules from OT are returned back to the pharmacy and the same is cross-checked with the entry made in the narcotic register.
• Return of empty ampoule is recorded in the OT register by the OT staff and the same is counter signed by the pharmacist.
• Hospital has brought documented policies and procedures to address the requirement and use of Narcotic Drugs and
• Psychotropic Substances Act and it also address the local and national regulations.
• It also describes issues related to procurement, secure storage, prescription, dispensing, administration and monitoring.
• Narcotics & Controlled Drugs are stored under a double lock system and has limited access. In a shift, only 2 authorized pharmacists (At least one should be a senior pharmacist) is allowed to access narcotic drugs. Key 1 for lock 1 and key 2 for lock 2 is given to the authorized pharmacist 1 and pharmacist 2 respectively. Narcotics drug storage double lock system can be opened only by using both the keys at the same time. The staffs associated with administering these drugs maintain a record of usage, administration and disposal of these drugs.

Records

1. Narcotic Drugs Register
2. Narcotic Purchase Record
3. Narcotic Sales Record file – Bill and Prescription

Upon issue, the pharmacist should enter the all below details in Narcotic Drugs Register

1. Name of Drug
2. Purchase invoice no.
3. Previous Balance
4. Purchase Quantity
5. Total Quantity
6. Sale Quantity
7. Balance Quantity
8. Name & Address of Patient
9. Name of Doctor
10. Bill No & Date
11. Balance
12. Pharmacists Sign

Medicines administered are recorded in the medication administration sheet in the medical record

A person responsible for procurement, storage, handling and issue is authorized and policies for usage guide the management of these drugs.