The UK Government has made the regulatory changes to the Misuse of Drugs Regulations 2001 to allow paramedic independent prescribers to prescribe and administer, and direct others to administer, the following five controlled drugs: Morphine sulfate, Diazepam, Midazolam, Lorazepam and Codeine phosphate.

The move comes four years after the Advisory Council on the Misuse of Drugs, working in conjunction with the College of Paramedics and NHS England, recommended the legislative changes which were accepted by the UK Government in 2022.

Since then, the College of Paramedics has worked tirelessly to seek clarification from the Home Office for a date when the amended legislation would come into effect. In September, Lord Butler of Brockwell led a short debate in the House of Lords to raise the same issue.

Tracy Nicholls, Chief Executive of the College of Paramedics said: “To achieve this result has really been about the efforts of many people over several years. The necessary legislative system, within which we must operate, has had a number of challenges over the last few years but I am keen that we focus on the positive which is the statutory instrument that allows the regulatory changes to the Misuse of Drugs Regulations 2001. It is our hope that these changes will enable our profession to operate safely, within a well-governed system to support optimal patient care for those who require our services, all without placing additional burden on colleagues within the systems which we work. My grateful thanks goes to our relevant Specialist Interest Groups and to those who supported the College at the House of Lords Short Debate, and in particular, Lord Butler of Brockwell and Lord Patel.”

David Rovardi, Specialist Medicines Adviser for the College of Paramedics added: “This change has been a long time coming but it’s a huge step forward for the profession and allows for the timely, safe and effective supply and administration of medicines to patients. It also presents the opportunity for paramedics to support patients with de-prescribing in line with NICE guidance on medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults.”

It is widely believed that the amended legislation will enable quicker access to medicines for patients, will relieve pressure in accident and emergency departments and will allow paramedics working at an advanced level of practice to be able to assess, diagnose and treat patients independently rather than refer them on to another healthcare professional.

There are currently over 1640 paramedic independent prescribers in the UK, all of whom have completed an approved prescribing programme and who work across a variety of settings including palliative care, GP surgeries, out-of-hours, specialist wards and critical care.

Helen Beaumont-Waters, Head of Clinical Development for Primary and Urgent Care at the College of Paramedics said: “Paramedics work in many different clinical settings and the changes to legislation will benefit both patients and the wider multi-disciplinary team. Primary care and urgent care paramedics will be able to complete episodes of care where previously a discussion with another clinician was needed - this saves time for the patient and reduces workload duplication. Discussions will now also be able to occur around de-prescribing when some controlled drugs are no longer appropriate. Furthermore, time-critical prescribing by a paramedic will improve patient care when certain anticipatory medication is needed, allowing a patient to be treated in a dignified manner if nearing end of life.”

Carl Smith, the College of Paramedics’ Head of Clinical Development for Emergency and Critical Care added: “This has been a massive achievement and a great example of how the College of Paramedics wants to push the profession and support its members to have the drugs they require to deliver safe, governed, and regulated care to patients, which must always be at the forefront of everything we do. There has been a considerable amount of work and time put into this and my thanks goes to all key stakeholders who have contributed to this amazing achievement.”