Advances in Prescription Drug Control: Proposals to Strengthen the Regulation of Psychostimulants, Z-Drugs, and Benzodiazepines in Brazil

OBJECTIVE: To analyze the Brazilian National Prescription Control System (SNCR) for controlled medications in light of international electronic prescription monitoring models and to identify opportunities for regulatory and clinical improvement in the control of psychostimulants, benzodiazepines, and Z-drugs. METHODS: A comparative narrative review of international prescription monitoring systems was conducted. Case studies were selected according to predefined criteria, including implementation of electronic monitoring systems for controlled medications, availability of official documentation and scientific literature, relevance to international regulatory debates, and diversity of healthcare systems. Models from the United States, Canada, Australia, and the United Kingdom were analyzed and compared with the Brazilian SNCR established under RDC No. 873/2024. RESULTS: The Brazilian SNCR represents an important administrative advance by centralizing prescription numbering nationwide, enabling digital prescriptions, and improving document traceability. However, the system remains primarily focused on sanitary surveillance and administrative oversight, without providing clinicians access to patients' dispensing histories or tools to identify potentially inappropriate prescribing patterns. In contrast, international models incorporate real-time clinical access, prescription monitoring, automated alerts, audit mechanisms, and prescriber feedback. Evidence from international experiences suggests these systems are associated with reductions in duplicate prescribing, medication misuse, prescribing errors, and adverse drug events. CONCLUSIONS: Although Brazil has advanced in the digitalization of controlled prescriptions, strengthening the SNCR will require a transition toward integrated clinical pharmacovigilance systems. International experiences support the incorporation of interoperability, real-time monitoring, and structured prescriber feedback to improve patient safety and promote the rational use of psychotropic medications.