Why Some Hospitals Don’t Keep Narcotics
Many small and mid-sized hospitals in India choose not to keep narcotic drugs in their pharmacy. That’s mainly because getting a license under the NDPS Act (Narcotic Drugs and Psychotropic Substances Act) involves heavy formalities—inspections, regular record submissions, physical verification, and audits.
For a hospital that uses these drugs only once or twice a year, the process may feel overwhelming and unnecessary.
But emergencies and critical cases don’t wait. What if you suddenly need Morphine for severe post-operative pain, or Fentanyl for a terminally ill patient? Not being prepared can affect both patient care and legal safety.
This article will guide you—step-by-step—on how to safely, legally, and confidently handle occasional use of narcotics without a full-time narcotics license.
When Might You Still Need Narcotics?
Even if your pharmacy doesn’t keep narcotics, you may come across these genuine clinical situations:
- After major surgeries, strong painkillers may be needed
- Cancer or palliative patients needing comfort care
- Visiting consultants bringing their own medication for a surgery
- Emergencies where opioids like Fentanyl or Pentazocine are lifesaving
These situations are rare but real—and your hospital must be ready with the correct SOP, documentation, and clarity.
What NABH and Law Say About It
Let’s make this very clear:
You are not required to stock narcotics if you don’t want to.
But if you use it even once, NABH and legal bodies expect full traceability and compliance.
Key rules to remember:
- Your pharmacy must not issue or handle narcotics unless it has a valid NDPS license
- You must maintain clear records of where the drug came from, who used it, and what happened afterward
- Even one-time use triggers legal responsibility
Many hospitals using SVeXcell support services get help creating SOPs and digital formats for this kind of rare use.
How to Know Which Drugs Are Classified as Narcotics
Not all injections or painkillers are narcotics. To avoid confusion:
- Visit your State Drug Control Department’s official website
- Look under headings like:
- “NDPS Approvals”
- “List of Controlled Substances”
- “Schedule H1 or Narcotics List”
- You’ll often find downloadable lists with brand names and salts
- Alternatively, speak to your District Drug Inspector for confirmation
Keep a printed copy of this list in the Medical Superintendent’s file and OT drug cupboard for clarity during audits.
Step-by-Step Guide to Handle Rare Use of Narcotics
1. Prepare a Formal Undertaking
Hospitals should keep a written statement such as:
“Our hospital pharmacy does not stock or sell any narcotic or psychotropic medicines. In rare, justified clinical situations, such medicines are brought by the treating consultant from a licensed pharmacy for patient-specific use. Their documentation and administration are supervised by the consultant.”
- Issue this on letterhead
- Sign by MS or hospital director
- Keep a copy in your Quality Manual and Audit Folder
📁 Many hospitals guided by SVeXcell include this under NABH Chapter 3B.
2. Keep a Proper Narcotic Use Register
Every time a narcotic drug is used—even once—record it in a dedicated logbook or digital sheet with:
- Patient name, IPD/OPD number
- Name of drug, dosage, strength, batch no., expiry
- Quantity brought, quantity used
- Route, time, and date of administration
- Doctor and nurse signatures
- Source of procurement (e.g., “Brought by Dr. XYZ from ABC Pharmacy”)
Hospitals using SVeXcell’s formats get structured digital or printable logs with all NABH-required fields.
3. Safe Storage (Double Lock and Access Control)
Even if you use narcotics rarely, you must ensure temporary safe custody of the drug while it’s in your facility. Here’s how:
Use Double Lock Storage:
- Store the medicine in a locked metal box, placed inside a locked cupboard or wall cabinet
- This is called a double lock system
- One key remains with the consultant doctor or in-charge nurse
- The second key is held by the Medical Superintendent (MS) or OT in-charge
The double lock ensures that no single person can access the drug alone, preventing misuse.
Access and Issue Control:
- Medicine should be taken out only at the time of administration
- Entry must be made in the narcotic register at the time of retrieval and administration
- Leftover (if any) must be returned and documented with reason
These precautions make even temporary storage compliant and defensible during audits.
4. Discard Ampoules and Wrappers Responsibly
After administration:
- Crush and discard empty ampoules, vials, or wrappers in the sharps container
- Always do this in the presence of a witness (e.g., duty doctor or another nurse)
- Document disposal in the remarks column like:
“Ampoule crushed and discarded, witnessed by Dr. XYZ”
Never keep leftover drug “for later.” This small step helps avoid legal and ethical trouble.
5. Pharmacy Must Not Handle the Drug
If you don’t have a narcotics license:
- Do not purchase, store, or issue the drug via your hospital pharmacy
- The treating doctor must bring the medicine in original packing
- It must be used for one patient only and not mixed with other stock
- Avoid entering it in indent slips or pharmacy bills
Even if your hospital pays for it, the procurement should remain off-record from pharmacy ledgers.
6. Train Staff and Include in Induction
Ensure nurses, doctors, and OT staff are trained in:
- Recognizing narcotic drugs
- Logging usage in MAR and narcotic registers
- Following disposal protocol
- Never storing it casually or reusing leftovers
Include these points in staff induction and refresher training. Hospitals using SVeXcell often integrate this into their annual training calendar.
7. Be Ready for Auditors and Inspectors
If NABH or Drug Inspectors ask about your narcotic policy:
Q: Do you stock narcotics?
“No, we don’t hold an NDPS license, so our pharmacy doesn’t stock or issue them.”
Q: What if a patient needs it?
“Our consultant brings the drug from a licensed pharmacy for that patient only. It’s documented, administered, and disposed of responsibly.”
Q: Do you have a log?
“Yes. Here is our register showing patient-wise usage and disposal notes.”
This open and structured approach earns respect—and ensures smooth audit closure.
Final Thoughts
Even if your hospital does not have a narcotics license, you can still deliver safe and legal care in rare, justified cases—if you plan ahead and follow best practices.
Here’s what makes the difference:
- Undertaking on record
- Double-lock safe custody
- Proper usage and disposal log
- No pharmacy involvement
- Staff trained and confident
And if you ever feel unsure, or need sample formats, SOPs, or register templates—you can contact SVeXcell at
contact@svexcell.com or
+91-9041489718 (Prince Kataria)
We specialize in helping hospitals like yours stay compliant, even when dealing with the rarest of situations.
