DAVID PRUCE, director of practice and quality improvement, Royal Pharmaceutical Society, replies:

Council members are required to make declarations of interest which are maintained in a register and published in the annual report. At Practice Committee meetings, like all other standing committees of the Society, it is normal practice for declarations of interest to be made by committee members before each agenda item being discussed. This practice was carried out and no members of the practice committee at the time made any declarations or conflicts of interest against this particular agenda item.

It is important to emphasise that the Practice Committee has not finished its deliberations on this subject and has not made recommendations to the Council regarding what action the Society should take.

The issue was raised with the Practice Committee following a number of queries that both the practice and quality improvement directorate and the fitness-to-practise directorate had received around strong opioid prescribing, fentanyl patches in particular. The overriding concern in the Practice Committee’s discussions has been patient safety. In 2004, the Department of Health published a report by the chief pharmaceutical officer entitled “Building a safer NHS for patients — improving medication safety”. This report explored the causes and frequency of medication errors, highlighted drugs and clinical settings that carried particular risk and identified good practice to reduce risks. Many of these recommendations are being addressed, especially by the National Patient Safety Agency. The report noted that potent opiate analgesics are frequently involved in serious medication errors (some fatal). It went on to make a number of recommendations to improve the safety of the use of potent opiate analgesics. One of these was that “oral sustained release opiates should be prescribed by brand name to reduce the risk of dispensing and administration errors”. The reasons behind the recommendation were the potential for confusion between sustained release and immediate release products and the large range of products available which can also lead to confusion. The catastrophic effects of medication errors involving potent opiates was of great concern.

The Practice Committee was also aware that fentanyl patches are sometimes halved in an effort to titrate the dose, although this is not a licensed use. The two formulations behave differently when halved.

The Practice Committee believed it was important to maintain continuity of supply of potent opiates analgesics in order to reduce the potential risk to patients. The committee is looking at a number of options to achieve this, including whether brand name prescribing should be encouraged. At its recent meeting, the Practice Committee agreed to ask British National Formulary staff whether they thought that there were sufficient grounds to recommend brand name prescribing in this case. The current BNF guidance on brand name prescribing does not advocate the brand name prescribing of opiates. The Society would not wish to issue guidance that conflicts with that of the BNF.