New Procedures for Harm Reduction Prescriptions Jan. 10, 2022

New Procedures for Harm Reduction Prescriptions

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 non-public–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.

Included drugs

Opioids (not necessarily part of official OAT)

• Fentanyl patches, tablets, and inhalable compounded options
• Hydromorphone tablets, injectables, and inhalable compounded options, except when prescribed as part of a formal iOAT, or TiOAT treatment program
• Morphine injectable, and immediate or sustained release tablets/capsules, except when prescribed for OAT
• Oxycodone immediate and sustained release formulations
• Sufentanil injection
• Diacetylmorphine (DAM)
  • Currently DAM is not part of harm reduction programs. If any form (e.g., inhalable compounded options, injectable) becomes available for harm reduction, the prescriptions should include the SA code, which should be entered with each fill/part fill.

Stimulants 

• Dextroamphetamine IR or SR
• Methylphenidate IR or SR
• Any other stimulants prescribed for harm reduction, either commercial or compounded

Benzodiazepines 

• Diazepam
• Clonazepam
• Any other benzodiazepines prescribed for harm reduction, either commercial or compounded

For additional informatoin and guidance on BC's Controlled Prescription Form, please visit: 

bcpharmacists.org/CPP