Board Highlights - November 23, 2018

Board Highlights - November 23, 2018

Highlights from this meeting include the introduction of four newly elected board members, amendments to the Drug Schedules Regulation, and a new Opioid Agonist Treatment Training Program. 

Welcome & Swearing in of New Board Members

The College of Pharmacists of British Columbia is pleased to welcome four newly elected representatives to its Board.

The College’s 2018 Board Elections took place earlier this year in District 2 (Fraser Valley), District 4 (Kootenay/Okanagan), District 6 (Urban Hospitals), and District 8 (Pharmacy Technicians).

The successful candidates (listed below), were sworn in at this month’s meeting.

Learn more about each candidate by clicking his/her name.

• Christine Antler, District 2 (Fraser Valley)
• Steven Hopp, District 4 (Kootenay Okanagan)
• Anca Cvacl, District 6 (Urban Hospitals)
• Bal Dhillon, District 8 (Pharmacy Technicians)

The College would like to thank all the pharmacists and pharmacy technicians who took the time to help select the best representatives from each district to join the College Board.

Board Chair and Vice-Chair Election Results

The College Board elections for Chair and Vice-Chair took place at the November meeting.

Chair: Arden Barry, District 7 – Community Hospitals representative, was elected Board Chair

Vice Chair: Christine Antler, District 2 – Fraser Valley representative, was elected Vice-Chair

Board Members of Chairs of Committees 

The Board approved a motion requiring that certain committees of the College of Pharmacists of British Columbia must have a Board Member as Chair. 

The following committees are now required to have a Board member as Chair in order to ensure that there is a strong connection with the Board: 

• Community Pharmacy Advisory Committee 
• Ethics Advisory Committee 
• Hospital Pharmacy Advisory Committee 
• Jurisprudence Examination Subcommittee 
• Practice Review Committee 
• Residential Care Advisory Committee 

The following committees will not require a Board member as Chair as they are statutory committees with independent decision making authority and, as such, do not make recommendations or report to the Board: 

• Application Committee
• Discipline Committee
• Drug Administration Committee
• Inquiry Committee
• Registration Committee 
• Quality Assurance Committee 

Lastly, the following committees are comprised entirely of College Board members and will thus already have a Board member as Chair: 

• Audit and Finance Committee
• Governance Committee 
• Legislation Review Committee

Potential Alternatives to the College’s Existing Quality Management Program 

The Board has directed the College’s Registrar to explore the implementation of mandatory medication error reporting to an independent third party. 

In July 2017, Melissa Sheldrick – a patient safety advocate whose son passed away due to a drug dispensing error in Ontario – requested that the College consider the implementation of mandatory medication error reporting. 

The Board then reviewed and discussed the issue at its November 2017 meeting, and decided to explore potential alternatives to the College’s existing quality management requirements, citing a general lack of information with respect to medication errors and incidents being collected and shared throughout the province. 

The implementation of mandatory medication error reporting aligns with the College’s duty to protect the public, as well as its vision of “Better health through excellence in pharmacy,” and Code of Ethics. 

Data analysis of medication errors has the potential to improve public safety nationally and provincially. Mandatory anonymous error reporting provides data that can be analyzed to help identify trends in errors that are occurring and provide opportunities to learn from mistakes, improve practice and better protect the public. 

Although sections 24(1) and 29(1) of the PODSA Bylaws currently require pharmacy managers of community and hospital pharmacies to develop, document and implement an ongoing quality management program, the specific requirements of the program are left to the discretion of the pharmacy manager, and the College does not assess the adequacy of the program.

Several provinces in Canada have also implemented, or are in the process of implementing, new quality management requirements that include mandatory error reporting to an independent third party.

The College will now develop a Request for Proposal (RFP) for third party vendors, define specific details of the program and ultimately develop a recommendation for a decision at the September 2019 Board Meeting. 

BCPHA Opioid Agonist Treatment Compliance and Management Program for Pharmacy (OAT-CAMPP) 

Bryce Wong, Director of Special Projects for the BC Pharmacy Association (BCPhA), provided the Board with an overview of the development of the BC Pharmacy Association’s new Opioid Agonist Treatment Compliance and Management Program for Pharmacy Training Program (OAT-CAMPP). 

In 2017, in consultation with the Ministry of Health (MOH), the BC Centre for Substance Use (BCCSU), the BCPhA and other stakeholders, the College updated Professional Practice Policy-66 Opioid Agonist Treatment (PPP-66) to include the addition of buprenorphine/naloxone and slow release oral morphine maintenance treatments as new opioid agonist treatment (OAT) options. These options augment the College’s existing methadone maintenance treatment (MMT) requirements.

After amending PPP-66 to reflect the new treatment options, a gap was identified in the College’s MMT training program in that it does not address the inclusion of buprenorphine/naloxone and slow release oral morphine maintenance treatment. 

In response to this, the BCPhA, in conjunction with the Ministry of Health, developed the OAT-CAMPP training program as a tool to help registrants address the province’s current opioid crisis. The training program aligns with PPP-66 and will replace the College’s current MMT training program. It provides training on buprenorphine/naloxone, methadone and slow release oral morphine maintenance treatments, as well as on opioid use disorder itself. 

The OAT-CAMPP training program will consist of both online and in-person components. 

The program will fully commence in January 2019. It has been proposed that within 6 months of the launch date, all community pharmacies that deliver OAT will have one pharmacist on staff complete the training program, and by March 2021, all pharmacists who dispense OAT in their practice will have completed the OAT-CAMPP course. Pharmacy technicians will only need to complete the online component of the training, as the in-person training is clinically-focused.

Learn more about the new OAT training requirements and transition period approved by the College Board. 

Drug Schedules Regulation – Scheduling by Reference 

The Board directed the Registrar to pursue drug scheduling by reference to federal legislation and the National Drug Schedules established by the National Association of Pharmacy Regulatory Authorities (NAPRA), with respect to the Drug Schedules Regulation (DSR).

Health Canada determines whether a drug must be sold by prescription only. Provincial regulatory authorities can further restrict the conditions of sale of non-prescription products, however they cannot be less stringent than the federal requirements.

Typically, for those drugs determined by Health Canada to be non-prescription, most provincial regulatory authorities schedule by reference to recommendations made by National Association of Pharmacy Regulatory Authorities (NAPRA) in the National Drug Schedules.

BC is one of the few provinces in Canada that maintains its own list of scheduled drugs in the DSR, which results in a longer process for amendments to be brought into force. Nevertheless, most amendments to BC’s DSR are based on recommendations from NAPRA.

Rather than listing each drug and the schedule it has been assigned, the DSR could instead reference the drug schedules established by external organizations, for example, Health Canada and NAPRA. Different provinces have difference models for scheduling by reference.  The following is an example of one model that has been used: 

The College will be examining the different approaches to scheduling by reference.

The College’s current approach of maintaining its own list of drugs under the DSR is problematic for several reasons: 

• The DSR is presented as a complete list of scheduled drugs, which it is not, and this confuses readers who may not be aware of the College’s approach to updating the DSR. 
• The federal government and NAPRA are continually updating their drug schedules, resulting in perpetual inconsistencies between the DSR and the federal drug schedules due to the lag times inherent in the process for DSR updates.  
• The regulations of several regulated health professions refer to the DSR. If the DSR is not up to date, it can unintentionally limit the scope of practice of those professions. 
• Under the Pharmacists Regulation, registrants may only compound and dispense a drug specified in the DSR. Therefore, pharmacists who compound and dispense drugs that are not listed on the DSR are technically in violation of that Regulation.
• Conducting a meaningful independent review of each drug scheduling decision is costly and time-consuming for the College and effectively duplicates the work of NAPRA’s National Drug Scheduling Advisory Committee. 

Pursuing drug scheduling by reference will address the above-mentioned issues and create significant efficiencies in the College’s drug scheduling decisions. 

ADDITIONAL AMENDMENTS TO THE DRUG SCHEDULES REGULATION (DSR) 

The Board approved amendments to the DSR under the Pharmacy Operations and Drug Scheduling Act  in order to address a scheduling gap, improve alignment with the Prescription Drug List made under the Food and Drugs Act, and the Schedules to the Controlled Drugs and Substances Act for Codeine, Lisdexamfetamine dimesylate, Nicotine, and Cannabinoids. 

CODEINE

Depending on its dosage form, codeine is currently scheduled on the DSR as a Schedule 1A or a Schedule II drug. However, these two categories do not capture the dosages of codeine found in Tylenol #2 and Tylenol #3. Therefore, a separate category, Schedule 1 codeine, will be created to address the scheduling gap. 

LISDEXAMFETAMINE DIMESYLATE

Lisdexamfetamine dimesylate will be added to the DSR as a Schedule I drug to align with the Schedules to the Controlled Drugs and Substances Act. 

NICOTINE

The nicotine qualifier in the DSR will be amended for alignment with recent changes to the PDL.

CANNABINOIDS

Phytocannabinoids (s.g. Sativex) and synthetic cannabinoids (e.g. Nabilone) that have been classified as prescription drugs by Health Canada will be added to the DSR in order to align with the Prescription Drug List and the Schedules to the Controlled Drugs and Substances Act. 

It should be noted that the Prescription Drug List only regulates the prescription status of health products containing cannabis and not other types of cannabis products such as cannabis for non-medical purposes.

The proposed amendments are not expected to result in significant changes to pharmacy practice.

EFFECTIVE DATE 
Subject to filing with the Minister of Health, the changes, other than the changes relating to cannabinoids, are expected to take effect in mid-January 2019. The changes relating to cannabinoids are expected to take effect shortly after the Board meeting, in late November or December.   

Professional Practice Policy – 66: Amendment to Training Requirements 

The Board approved amendments to Professional Practice Policy-66: Opioid Agonist Treatment in order to have it align with the above-mentioned BCPhA Opioid Agonist Treatment Compliance and Management Program for Pharmacy Training Program (OAT-CAMPP).

The new training program is aimed at reducing stigma and expanding pharmacists’ knowledge about methadone, buprenorphine/naloxone and slow-release oral morphine. The program also aims to improve the experience and engagement of people receiving treatment. It supports the College’s Opioid Agonist Treatment requirements and will eventually replace the College’s current Methadone Maintenance Treatment (MMT) training program. 

Transition Period

This amendment will be effective starting on January 1, 2019. A transition period will take place over the January 1, 2019 to March 31, 2021 during which PPP-66 will require pharmacy managers, staff pharmacists, relief pharmacists and pharmacy technicians employed in a community pharmacy that provides services related to buprenorphine/naloxone maintenance treatment, methadone maintenance treatment or slow release oral morphine maintenance treatment to complete either the College’s existing MMT training program or the BCPhA’s new OAT-CAMPP course.

Pharmacy technicians will only need to complete the online component of OAT-CAMPP. The content of the in-person workshop focuses primarily on clinical cases that are not as relevant for pharmacy technicians.

The MMT training program will be removed at the end of the transition period. By March 31, 2021, completion of MMT training program will no longer fulfill the training requirement outlined in PPP-66. 

During the transition period, registrants employed in a community pharmacy that provides pharmacy services related to opioid agonist treatment are strongly encouraged to complete the OAT-CAMPP program as soon as practical.

Developing a Pharmacy Professional Master’s Degree Program in a Changing Education Landscape 

Dr. Patricia Gerber, Director of Degree Programs for Pharmacists at the UBC Faculty of Pharmaceutical Sciences, outlined for the Board the current efforts to develop a new Pharmacy Professional Master’s degree program at UBC.

Amid the expansion of pharmacists’ roles and the advancement of practice, the pharmacy education landscape has seen significant changes marked primarily by the replacement of the B.Sc. Pharm entry-to practice degree with the PharmD degree. Within BC, these changes occurred at a time of evolution of residency programs and the closure of the UBC Graduate PharmD Program. The closure of the latter, which was a major source of professional leaders for over two decades, represents a loss of a path that was meeting some but not all of the profession’s needs for individuals equipped to continue to advance the profession.

Although some pharmacists pursue residency training or non-pharmacy-specific programs (e.g. MBA), there is no longer a pharmacy-specific educational path for pharmacists to become professional leaders. This gap presents a new opportunity for developing a different kind of degree program, one that will graduate leaders, innovators, and advocates equipped with knowledge and skills relevant to the advancement of the profession via legislative and regulatory changes, expansion of integrated health teams, and evolving practice models. 

Pharmacist Providing Anti-psychotic Depot Injections 

The Board approved the delegation of a Medical Act authorizing pharmacists from Pro-Health Pharmacy in Chilliwack, BC, to administer anti-psychotic depot injections. This request was also recently approved by the College of Physicians and Surgeons of BC.

The aim of this delegation is to address the high demand for mental health services in Chilliwack which are reportedly at over-capacity. 

The delegation involves administering the following medications via depot injection: aripiprazole, paliperidone, olanzapine, haloperidol, risperidone, zuclopenthixol and flupentixol. All pharmacists involved in the delegation will undergo training and a period of supervision by a physician. The pharmacists will also provide medication counselling and medication reviews when necessary and appropriate. These medication reviews will be transmitted to Chilliwack Mental Health for collaboration with a psychiatrists and the nursing team.

Currently, the administration of depot injections for anti-psychotic medications is outside of the scope of practice of BC pharmacists. BC pharmacists are only authorized to provide immunizations by injection. The College’s Drug Administration Committee is exploring broadening the types of drugs that may be administered by injection.

Pharmacists involved in the above-noted request will be permitted to administer depot injections via a Delegation of a Medical Act by the College of Physicians and Surgeons of BC. When a Medical Act that is outside the accepted scope of practice of another discipline is delegated, the responsibility for that act is shared. 

CLEAR Regulatory Excellence Award – College of Pharmacists of BC 

On September 28, 2018, the Council on Licensure, Enforcement & Regulation (CLEAR), presented the College with the 2018 Regulatory Excellence Award for our work on pharmacy security measures.

The CLEAR Regulatory Excellence Award recognizes an individual, team, program or agency demonstrating an outstanding contribution to the enhancement of occupational or professional regulation, regulatory processes, or consumer and public protection.

From 2012 to 2013, pharmacies in Vancouver, British Columbia experienced a 160% increase in community pharmacy robberies, often targeted for their prescription opioid medications. After being contacted by the Vancouver Police Department about the distressing number of pharmacy robberies, the College formed a working group to examine the issue comprised of representatives from law enforcement, pharmacies, College staff and the BC Pharmacy Association. The working group developed a set of pharmacy security requirements aimed at reducing pharmacy robberies and protecting confidential patient health information. The cornerstone was a requirement that all community pharmacies store their narcotic drugs in a time-delayed safe. The measures were first introduced via policy in 2015, and transitioned to bylaw in 2017. 

The College recently commissioned and received an evaluation of the pharmacy security measures by Dr. Martin Andresen, Professor of Criminology and Director of the Institute for Canadian Urban Research Studies at Simon Fraser University. 

Dr. Andresen analyzed changes in trends in the number of pharmacy robberies before and after the measures came into effect. 

The evaluation found strong evidence supporting the notion that the measures had their intended effect across the province. Notably in Vancouver, where the majority of pharmacy robberies occurred, there was an immediate and substantial drop (94%) in pharmacy robberies after the College’s pharmacy security requirements took effect. 

The College would like to thank all those who contributed to the initiative, as well as CLEAR for recognizing our work. Receiving this award helps to reinforce the important impact that our work on pharmacy security has had on public safety in communities across the province. 

Committee Updates 

The following College Committees provided updates on their activities since the previous Board meeting: 

• Governance Committee 
• Hospital Pharmacy Advisory Committee
• Inquiry Committee
• Practice Review Committee
• Audit and Finance Committee 
• Quality Assurance Committee 
• Community Pharmacy Advisory Committee 
• Jurisprudence Examination Subcomittee 
• Discipline Committee 
• Legislation Review Committee 
• Registration Committeee 
• Application Committee 
• Ethics Advisory Committee
• Residential Care Advisory Committee
• Drug Administration Committee

RECAP OF THE BOARD MEETING ON SOCIAL MEDIA

November 2018 Board Meeting