The Alberta government has announced amendments to the Mental Health Services Protection Regulation under the Mental Health Services Protection Act. The Regulation was initially created to establish a regulatory framework for Albertans accessing supervised consumption services. The recent amendments also introduce new Narcotic Transition Services as well as provincial oversight for the emerging field of psychedelic drug treatment services. Alberta Health’s Narcotic Transition Services fact sheet provides more information about these changes, including detail about hospital-based exemptions to certain requirements.
Some changes to the Regulation come into effect immediately, while for others, time will be provided to allow service providers and other stakeholders to be educated about changes, licensing models to be developed, and, for patients directly impacted by the changes, time to work with their service providers to transition care as safely and as effectively as possible.
Designated narcotic drug changes
The amendments to take effect immediately include significant changes to the way certain opioids, referred to as “designated narcotic drugs” may be prescribed, dispensed, compounded, and administered. As of October 5, 2022, the following changes are in effect:
- The Mental Health Services Protection Regulation defines a “designated narcotic drug” as any full-agonist opioid drug with the exception of methadone or slow-release oral morphine. Designated narcotic drugs include hydromorphone, diacetylmorphine, oxycodone, morphine, and fentanyl, but does not include drugs for treatment of opioid agonist therapy such as buprenorphine, slow-release oral morphine, and methadone.
- An authorized regulated health professional may not prescribe, administer, compound, dispense, or sell a designated narcotic drug for opioid use disorder, except as permitted by the Mental Health Services Protection Regulation.
- A pharmacist or other authorized regulated health professional may not dispense any prescription of a designated narcotic drug unless the prescription includes the medical indication for which the drug is being prescribed (i.e., on the TPP Alberta form).
- A designated narcotic drug may not be dispensed directly to a patient if the prescription is indicated for an opioid use disorder.
- Any administration of a designated narcotic drug for an opioid use disorder must happen at the location of a licensed AHS clinic and will be supervised by an authorized regulated health professional to protect against diversion. AHS has two licensed clinics in operation (in Calgary and Edmonton), with licensed clinics opening in other zones over the coming months.
Exemptions
Note that primary care providers who have been providing services for a patient’s opioid use disorder using these drugs (called “existing service providers”) since July 1, 2021, are temporarily exempted from points 4 and 5 above, as are any pharmacists and pharmacy technicians who dispense their prescriptions. For these service providers only, note the following:
- As of November 4, 2022, new patients can no longer be initiated on these drugs for their opioid use disorder outside of a licensed AHS clinic.
- As of March 4, 2023, all patients receiving these drugs for opioid use disorder must have been transitioned to conventional OAT or transferred to an eligible, licensed AHS clinic.
New requirements for pharmacists
These amendments have an immediate effect on how pharmacists deliver care to patients.
Pharmacists must
- be aware of the dates above and collaborate with patients and prescribers to help transition care when required,
- ensure every designated narcotic drug prescription dispensed has an indication provided by the prescriber, and
- NOT renew a prescription for a designated narcotic drug for a patient if the indication is for opioid use disorder.
Stay tuned to future editions of The Link for more on supporting patients through any required changes to their care.
