Controlled Prescription Program

CONTROLLED PRESCRIPTION PROGRAM

The Controlled Prescription Program (CPP) aims to reduce inappropriate prescribing of selected controlled drugs and to prevent forgeries. Prescriptions for the controlled drugs specified in the program must be written on the duplicate prescription pad specially developed for this purpose.

Program Partners

• BC College of Nurses and Midwives
• College of Dental Surgeons of BC
• College of Pharmacists of BC
• College of Physicians & Surgeons of BC
• College of Veterinarians of BC
• Ministry of Health (PharmaCare Program)

Representatives from each of these organizations make up the Controlled Prescription Program Advisory Committee which is responsible for regularly reviewing and updating the Controlled Prescription Program requirements and drug list, and making recommendations regarding drugs that should require a duplicate prescription, and the information that should be provided by registrants of each college on a duplicate prescription.

In addition, the committee provides a collaborative forum to discuss common concerns and knowledge related to prescribing of drugs with a high-risk profile. Best practices discussed by the forum also help guide development of related College standards for health professionals.

Under section 19(6)(a) of the College of Pharmacists of BC’s Bylaws under the Pharmacy Operations and Drug Scheduling Act, the controlled prescription form must be approved by the Boards of both the College of Pharmacists of BC and the College of Physicians and Surgeons of British Columbia.

In addition, under section 22(1) of the Pharmacy Operations and Drug Scheduling Act the College of Pharmacists of BC is also responsible for making amendments as needed to the Drug Schedules Regulation, which specifies the terms and conditions for the sale of drugs in the province.

How the Program Works

The selected drugs included in the program may only be prescribed in writing using a special Controlled Prescription Program duplicate pad printed for the purpose.

Once the prescription is written, the prescriber retains the bottom copy marked “PRESCRIBERS COPY” and provides the patient with the original identified as “PHARMACY COPY,” which the patient gives to the pharmacist.

Verbal and Faxed Prescriptions

There is no longer a need to send the original hard copy of duplicate prescriptions to the pharmacy following faxing or submitting a verbal prescription. Prescribers are still required to issue the prescription of controlled drugs (Schedule 1A drugs) from a duplicate prescription pad.  Prescribers can, of course, still give original copies of the duplicate prescription to their patients to bring to the pharmacy themselves.

During the pandemic, temporary amendments were made to CPBC bylaws to permit faxing and verbal transmission of these prescriptions, however, it was still necessary for prescribers to send the original prescription to pharmacies. As of April 17, 2023, this is no longer required.

As always, and in all situations, an identical copy of the original duplicate prescription must be kept with the patient medical record. Either the blue (or yellow) copy of the duplicate prescription must be retained with a paper record, or a digital image of the prescription must be placed in an electronic medical record. 

Note: Controlled Prescription Program duplicate prescription pads must still be used when using Electronic Medical Records (EMRs). As with all prescriptions, prescribers must ensure that all fields on Controlled Prescription Program forms are completed correctly including one generated from an EMR.

The Controlled Prescription Program also includes requirements and guidance on:

• ordering duplicate prescription pads
• safe keeping and reporting lost, stolen, or forged prescription pads
• voiding a duplicate prescription pad
• record retention
• prescription from delivery options, including mailing and receipt of forms to pharmacy

Drugs Included in the Program

The list of drugs covered by the program has been agreed to by all the program participants. Unless otherwise specified, both single-entity products and preparations or mixtures of the scheduled drugs require the use of Controlled Prescription Program forms.

Drugs included in the program are listed as Schedule 1A drugs in the Drug Schedules Regulation under the Pharmacy Operations and Drug Scheduling Act. 

Prescriptions for long-term and extended-care facility patients do not require the use of Controlled Prescription Program forms.

When are CPP forms required for residential care facilities, hospices and hospitals?

CPP form requirements for pharmacies serving residential care facilities, hospices and hospitals depend on whether the facility satisfies specific requirements outlined in Pharmacy Operations and Drug Scheduling Act.

Based on current PODSA Bylaw Section 4(8): Subsection (6) (Requirement for CPP forms for certain drugs) does not apply to prescriptions written for (a) residents of a facility or home subject to the requirements of the Residential Care Facilities and Homes Standards of Practice, or ­­­ (b) patients admitted to a hospital.

To expand upon subsection 4(8)(a), to qualify for CPP exemption, facilities or homes served by community pharmacies must meet the “Residential Care Facilities and Homes Standards of Practice” INCLUDING licensure under the “Community Care and Assisted Living Act” (CCALA).  Both of these requirements must be met for a facility or home to be exempt from the use of CPP forms.  

We’ve mapped out what this looks like in practice with a Controlled Prescription Program Guidance Flow Chart.

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Note: More than one strength of medication can be included on one Controlled Prescription Program form, provided the orders are legible.

The following summary highlights many of the Schedule 1a drugs that drugs require the use of a Controlled Prescription Program form:

Note: product names are examples only and are not intended to represent a complete list of all products available.

The following drug products are not Controlled Prescription Program drugs and do NOT require the use of a Controlled Prescription Program form:

Controlled Prescription Program Form

The Controlled Prescription Program Form is a specialized duplicate prescription with additional security measures to prevent forgeries. The duplicate prescription forms are prepared by the Ministry of Health and are only available to the following practitioners through a secure ordering process:

• Dentists
• Nurse Practitioners
• Physicians
• Registered Midwives
• Registered Nurses
• Registered Psychiatric Nurses
• Veterinarians 

In June 2021, a harmonized Controlled Prescription Program Form was introduced. The harmonized form combines the generic CPP form used for the majority of controlled prescriptions and the methadone CPP form, which is used to prescribe methadone for maintenance treatment. 

The harmonized CPP form reflects updated Opioid Agonist Treatment (OAT) delivery guidance and no longer requires physician authorization for delivery. Pharmacists are expected to use their professional judgement to determine whether or not to deliver OAT to a patient in accordance with the College of Pharmacists of BC’s Professional Practice Policy – 71 (Delivery of Opioid Agonist Treatment). Prescribers are also able to specify when delivery is not permitted.

See additional information on the development of the new harmonized CPP form

See the following examples of how to use the harmonized CPP form for different types of prescriptions.

For questions on how to complete a CPP form, please reach out to your respective College.

Buprenorphine/Naloxone Maintenance Treatment

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Methadone Maintenance Treatment

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Note: in the following example, "Not Authorized for Delivery has been selected by the prescriber, which means the pharmacist cannot deliver the prescription.

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Slow-Release Oral Morphine

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Pharmaceutical Alternative (for Safe Supply)

Note: The OAT area on the CPP form is not required to be filled out for drugs prescribed as a safe supply pharmaceutical alternative.

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Prescribers and pharmacists are asked to add “SA” (safer alternative) to prescriptions and PharmaNet entries for prescribed harm reduction drugs. This will improve data for safer supply programs and identify unintended risks or harms. Prescribed harm reduction drug options are outlined in the Risk Mitigation Interim Clinical Guidance, the Opioid Use Disorder Practice Update, and the Access to Prescribed Safer Supply Policy.

Most prescribed alternatives to the toxic, illicit drug supply are also used for other indications (e.g., pain). Identifying prescriptions as SA allows programs run by the BC Centre on Substance Abuse, the Ministry of Mental Health and Addiction, and the Ministry of Health to monitor, evaluate, and better mitigate the opioid public health emergency.

• Instructions for Prescribers

  When writing a prescription for a drug to be used as an alternative to the toxic street supply (i.e., for risk mitigation during the dual public health emergencies or as a safer supply option), clearly add “SA” at the bottom of the Directions for Use section of the BC Controlled Prescription form. (See example)

  “SA” tells the dispensing pharmacist to tag the prescription with a (non-public) identifying code, for program evaluation purposes, in PharmaNet.
   

• Instructions for Pharmacists

  When entering a prescription in PharmaNet (new or refill/part-fill) for any drug identified as a safer alternative, or for risk mitigation to support self-isolation or quarantine due to COVID-19, enter the “SA” intervention code. Prescribers have been asked to add SA at the bottom of the Directions for Use section (see example). If they use a different notation (e.g. RMG, safer supply), also enter these with the SA code.

  This SA code goes in the intervention code field. It acts as a nonpublic–facing tag so that the prescription can be identified as a safer alternative for program evaluation. The code does not go in the prescription direction. Entering the intervention code with each prescription is the only action required by pharmacists. There is no PharmaCare fee attached. 

iOAT – Hydromorphone

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Other Schedule 1a Drug included in Controlled Prescription Program

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Patient Delivery Options

Unless otherwise indicated, a pharmacist may deliver controlled drugs to a patient based on their professional judgement if they feel delivery is appropriate and in the best interest of the patient.

A prescriber may indicate that delivery is not permitted:

• For drugs prescribed for opioid agonist therapy, prescribers can use the NOT AUTHORIZED FOR DELIVERY option on the new harmonized CPP form. 
• For drugs prescribed for opioid agonist therapy using the existing CPP forms, or for other drugs included in the Controlled Prescription Program, prescribers can indicate “Do Not Deliver” on the form or directly communicate with the pharmacist.

Prescribers and Pharmacists should watch for updates on these temporary amendments from their College.  

Note: The College of Pharmacists of BC’s Professional Practice Policy-71: Delivery of Opioid Agonist Treatment sets out specific requirements for pharmacists and pharmacy managers working in community pharmacy settings on the delivery of opioid agonist treatment (OAT) drugs by pharmacists directly to patients. This includes a requirement for pharmacists to ensure the decision to deliver or to not deliver (including the rationale for the decision) is reflected in the patient’s record.

Ordering Duplicate Prescription Pads

Duplicate prescription pads are ordered through a prescribers' respective College.

The processing time for orders is 2-3 weeks. To ensure the safety and security of the pads, prescribers should always sign for deliveries of the pads.

Orders should be mailed to the work address listed on file with your College and located within the province of British Columbia. Prescribers need to contact their respective college to change their address for the delivery of the pads.

Note: For prescribers who have multiple work addresses, please contact your College to determine the delivery address. Delivery of the prescription pad to your home address may also be acceptable under extraordinary circumstances, but only after discussion with your College.

Dentists

Dentists need to complete the Harmonized Prescription Pad Order Form and submit it to their College.

Email	[email protected]
Mail	College of Dental Surgeons of BC 110 - 1765 W 8th Ave, Vancouver, BC V6J 5C6​

Note: Dentists need to contact the College of Dental Surgeons of BC to determine where the order of prescription pads should be sent to (location is determined on a case by case basis).

Nurse Practitioners, Registered Nurses, Registered Psychiatric Nurses, and Registered Midwives

Nurse practitioners, registered nurses, registered psychiatric nurses and registered midwives need to submit orders online through their BCCNM account.

Physicians

Physicians need to submit orders online through their CPSBC Account

Veterinarians

Veterinarians need to complete the Harmonized Prescription Pad Order Form and submit it to their College.

Email	[email protected]
Fax	604-929-7095
Mail	College of Veterinarians of BC Airport Excecutive Park (Building 7) 10991 Shellbridge Way, Suite 210, Richmond, BC V6X 3C6

Record Retention

Records should be retained in accordance with requirements by respective Colleges.

• For prescribers, do not retain the completed duplicate blue copies in the prescription pad. The duplicate copies should be filed with client/patient health records as per employer’s medical records management policies. Electronic copies of the prescription are acceptable but must be kept with the patient’s record.
• Pharmacists must keep a paper copy - original or faxed - of the CPP prescription form. The paper copy of the prescription must be filed with the patient’s record. Electronic copies of the prescription, if any, must be filed with the dispensing record.

Lost, stolen, or forged prescription pads

Prescribers must ensure secure storage of the prescription pads. If you are concerned that a prescription pad has been lost, stolen, misplaced or forged, or if you did not receive a prescription pad order within specified delivery time, you should contact your respective College as soon as possible.

Prescribers can also report a lost or stolen prescription pad or duplicate prescription pad to PharmaNet Support Services for communication to pharmacies via FanOut.

Voiding a Prescription Pad

Physicians and Veterinarians

For physicians and veterinarians, unused pads can be securely disposed of through confidential shredding.

Nurse Practitioners, Registered Nurses, Registered Psychiatric Nurses, and Registered Midwives

Nurse practitioners, registered nurses, registered psychiatric nurses, and registered midwives are no longer required to return unused controlled prescription pads to BCCNM. BCCNM registrants must confidentially shred their pads if they:

• Are on an extended leave
• Change their registration status to non-practising or inactive
• Change employers or the information on their pad is not current, or
• They are instructed to do so by BCCNM staff

Registrants who do not have access to confidential shredding or waste to securely dispose of unused CPP pads should email [email protected] to request a pre-paid addressed envelope to return their pads to BCCNM.

Dentists

You must return all partially and fully unused prescription pads to CDSBC offices (by XpressPost or courier) for shredding if any of the following occur:

• You move your practice out of BC
• You change your registration class to non-practicing
• You resign or retire from practice in BC
• You are instructed to do so by CDSBC staff

Additional Information

Prescription forms are personalized and numerically recorded and cannot be exchanged between prescribers.

Prescribers have been advised that failure to complete the prescription forms may result in rejection of the prescription by the pharmacist with resulting patient and prescriber inconvenience. However, if the prescription includes all the information required in pharmacy legislation, the medication may be dispensed.

More than one strength of medication can be included on one Controlled Prescription Program form, provided the orders are legible.

“Part-fills” are not encouraged but are acceptable, subject to the usual legal and recordkeeping requirements. The total quantity of drug being prescribed, the quantity to be dispensed on each “part-fill” and the interval of time to be observed between these fillings must be specified.

Outpatient prescriptions written at hospital emergency and outpatient departments for a Schedule 1a drug must be written on a Controlled Prescription Program duplicate form.

“Void after 5 days” means that the prescription cannot be honoured after midnight of the fifth day following the date of issue. Therefore, a prescription written on January 10th can be accepted for filling or logging on until midnight January 15th.

Program Contacts

For any specific questions not answered through the Controlled Prescription Program information document, please contact your respective regulatory College for further details.