Providing Care for OAT and iOAT Clients Over the Winter Holidays

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Providing Care for OAT and iOAT Clients Over the Winter Holidays

With the winter holidays approaching and many pharmacies adopting holiday hours, it is important for pharmacists to ensure that they are able to accommodate the dosing schedules of clients receiving Opioid Agonist Treatment (OAT). 

BCCSU – Updated Provincial Guidelines for managing opioid use disorder

Following the Provincial Guidelines for the Clinical Management of Opioid Use Disorder, Opioid Agonist Treatment - including buprenorphine/naloxone, methadone, and slow-release oral morphine - is provided to many clients at pharmacies across BC. 

BCCSU 24/7 Addiction Medicine Support Line for Pharmacists

A 24/7 support line for clinicians and pharmacists is available through the BCCSU, offering live, in-the-moment addiction medicine support while they are meeting with clients across British Columbia.

  • See bccsu.ca/24-7 for additional information including contact information.

British Columbia continues to experience a significant number of unregulated toxic drug injuries and deaths, with at least 1,749 lives lost to toxic drugs in the first nine months of 2024. 

Many clients with Opioid Use Disorder require supervised or witnessed dosing, meaning that their prescription requires them to visit their pharmacy daily to both obtain and ingest their dose of OAT therapy under the supervision of a pharmacist.

During the winter holidays, contacting prescribers and other health practitioners can be challenging. In situations where a client’s practitioner cannot be reached to clarify concerns or provide direction, CPBC expects registrants to use their professional judgment to act in the best interests of their clients and to ensure clients receive safe and accessible treatment.

Earlier this year, amendments to Professional Practice Policy 58: Adapting a Prescription (PPP-58) enabling pharmacists to adapt for more medications came into effect, providing pharmacists with additional flexibility to adapt prescriptions for narcotics, controlled drugs and targeted substances, including Opioid Agonist Treatment. 

As part of these changes, pharmacists may now: 

  • For continuity of care, renew prescriptions for a narcotic, controlled drug, or targeted substance for a duration that may be longer than prescribed.
    • Controlled substances, including Opioid Agonist Treatment drugs, may be renewed for a period that does not exceed the same duration as prescribed, or 30 days, whichever is greater.
    • Renewals of prescriptions for narcotic, controlled drug, or targeted substances are only permitted under a section 56 exemption to the Controlled Drugs and Substances Act.
  • Change the dose, formulation or regimen for a prescription for a narcotic, controlled drug, or targeted substance as long as the quantity dispensed does not exceed the stated amount authorized in the prescription.
    • Changes to the dose, formulation or regimen for a narcotic, controlled drug, or targeted substance prescription are permitted for the same clinical reasons already specified in PPP-58 for other drugs.
    • As is already the case for other drugs, pharmacists may change the dose, formulation, or regimen of a prescription for a narcotic, controlled drug, or targeted substance if the provided information is incomplete or ambiguous. In such cases, the intended treatment must be determined through consultation with the client and a review of the client’s record.
Documentation and Communication
  • Registrants should document their intervention, including steps taken to contact the client’s prescriber, their therapeutic rationale, and the plan for follow-up.
  • Registrants should communicate their treatment interventions to the client’s practitioners as soon as possible and retain proof of this communication.
OAT and Holiday Operating Hours

Under Professional Practice Policy-66: Opioid Agonist Treatment and the Policy Guides for Methadone, Buprenorphine/Naloxone, and Slow Release Oral Morphine Maintenance Treatment, a pharmacy’s hours of service must be consistent with the dosing requirements of the client.

This means pharmacists MUST check the start and end dates of a prescription, together with any dosing directions in consultation with the client to ensure that the client’s specific needs can be accommodated at their pharmacy BEFORE accepting the prescription. 

For example, a pharmacist would need to ensure that the authorization for dispensing does not end on a day when the client will not be able to see a prescriber for a new prescription (such as weekends and holidays). They would also need to review the dosing schedule included in the prescription directions (daily witnessed ingestion, take-home doses), including the specific dates and days of the week for each witnessed dose or take-home doses, to confirm that the pharmacy operating hours match the dosing schedule.

While a pharmacist may request a prescriber to write a prescription for carries to accommodate the holiday schedule, they must consider the client’s needs first. For impacted clients, any changes to their normal schedule can be disruptive to their care and may leave them without needed support and monitoring.

If a pharmacy cannot accommodate a client’s dosing schedule during their holiday operating hours, the pharmacist may refer the client to another pharmacy or collaborate with them to arrange alternate opening hours to ensure they receive their prescribed dose.

Temporary Authorization for Controlled Drugs and Substances

On March 19, 2020, Health Canada issued a temporary exemption for prescriptions of controlled substances under the Controlled Drugs and Substances Act and its Regulations, to support access to controlled substances when needed for medical treatments. 

Controlled Drugs and Substances Act - Subsection 56(1) Class Exemption for Clients, Practitioners and Pharmacists Prescribing and Providing Controlled Substances in Canada During the Coronavirus Pandemic.

Extension of Temporary Authorizations for Controlled Drugs and Substances

This temporary exemption: 

  • Permits pharmacists to extend and renew prescriptions; 
  • Permits pharmacists to transfer prescriptions to other pharmacists; 
  • Permits practitioners to verbally prescribe prescriptions for controlled substances; and 
  • Allows an individual to deliver controlled substances to clients (at their homes or an alternate location).

The College Board supports the Health Canada temporary exemption through the Pharmacy Operations and Drug Scheduling Act (PODSA) Bylaws, as well as the Community Pharmacy Standards of Practice made under the Health Professions Act to align with this exemption. This temporary exemption also supports pharmacists’ ability to adapt prescriptions for narcotics, controlled drugs and targeted substances, including Opioid Agonist Treatment, as outlined in the amendments to PPP-58 discussed earlier in this article. 

Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists

Temporary amendments to Professional Practice Policy-71: Delivery of Opioid Agonist Treatment (PPP-71) that allow pharmacists to authorize regulated health professionals with the appropriate scope and competence, as well as pharmacy employees, to deliver OAT, have been in effect since April 7, 2020. 

The temporary amendments allowing pharmacists to authorize pharmacy employees to deliver OAT on a pharmacist’s behalf should be reserved for exceptional circumstances where it is not possible for a pharmacist or other regulated health professional to deliver the OAT drug. 

ADDITIONAL RESOURCES
Dec 05, 2024