Schedule I and II controlled substances and ethyl alcohol require vault or safe storage and inventory by the Controlled Substance Inventory Board (discussed in more detail in the section entitled "Inventory of Controlled Substances"). Working stock may be kept in a locked area within the pharmacy. A copy of the safe combination must be kept in a sealed envelope
deposited with the CO or representative.

Schedule III, IV, and V controlled substances require locked cabinet security for storage of bulk drugs. A minimum amount of working stock may be dispersed among other pharmacy stock, provided the pharmacy stock itself is secure. Otherwise, all stock in this category must be kept in locked cabinets.

Custodial responsibility for controlled substances, ethyl alcohol, and dangerous drugs at naval hospitals is entrusted to a commissioned officer or a civilian pharmacist who is appointed in writing by the CO. At remote branch clinics that do not have a commissioned officer or a civilian pharmacist, the CO will designate

In writing a member of the branch clinic as custodian. On board large naval vessels, the CO will appoint an officer of the Medical Department or another officer in writing as the bulk custodian. This officer will be responsible for, and maintain custody of, all bulk controlled substances. On board smaller naval vessels, access to controlled substances is limited to the bulk custodian and the senior medical department representative (SMDR). Only individuals whose official duties require access to such spaces are provided the safe combinations.

INVENTORY OF CONTROLLED SUBSTANCES

Monthly (or more frequently, if necessary), the Controlled Substances Inventory Board takes an unannounced inventory of controlled substances.

NOTE: An exception to this frequency may be made for ships with an Independent Duty Corpsman. On these ships, the inventory may be conducted on a quarterly basis if there have been no transactions of controlled substances (including filled prescriptions or receipts of items requisitioned from supply).

The CO appoints the members of the board in writing. The board consists of three members, at least two of whom are commissioned officers. After the board conducts the inventory, it submits a report to the CO. The officer having custodial responsibility cannot be a member of the board. On small ships and installations, the SMDR may be a board member. For further guidance on controlled substance inventory procedures, refer to NAVMEDCOMINST 6710.9, Guidelines for Controlled Substances Inventory.

SURVEY OF CONTROLLED SUBSTANCES
Schedule I and II controlled substances, ethyl alcohol, and locally controlled drugs that have become outdated, deteriorated to the point of not being usable, are of questionable purity or potency, or have had their identity compromised, must be reported to the CO. If destruction is indicated and directed by the CO, destruction must be accomplished in the presence of a member of the Controlled Substance Inventory Board. A certification of destruction form contains the complete nomenclature and quantity of the substances to be destroyed together with the method of destruction to be used. After certification is completed, approved by the CO, and signed by the members witnessing the destruction, the certification of destruction is retained and filed as required by current instructions. The destroyed substances should then be removed from the stock records and the controlled substance log.

SUMMARY
Inpatients and the majority of outpatients will receive pharmaceutical products as part of their treatment. As a healthcare provider who may administer these products or fill prescriptions, it is crucial for you to have a good foundation of knowledge in pharmacology, toxicology, and the proper handling of prescriptions and controlled substances. This chapter touched on each of these topics to assist you in your duties. However, you should consult the recommended publications, such as the Manual of the Medical Department, Drug Facts and Comparisons, and the Physicians' Desk Reference, to provide you with the guidance and knowledge you will need to provide the best possible care for your patients.