The college has been alerted to multiple recent incidents where pharmacists provided methadone doses beyond the prescription expiry date. This practice can (but thankfully didn’t) have fatal consequences.
In all the cases reported to us, the physicians had made alternate arrangements for their patients. By dispensing doses after the prescription’s expiry date, the pharmacists could have contributed to double dosing.
These errors highlight the potential for significant patient harm if methadone dosing instructions and prescription expiry dates are not adhered to. It can also become a significant public safety issue, because methadone on the street is at a premium right now.
If you dispense methadone:
- Always enter the prescription expiry date when you enter the quantity in any record (computer, as well as any paper copies that staff may reference).
- Follow all directions on the prescriptions (included on each prescription in the recent incidents was the order: **Under no circumstances should a dose be provided beyond the last date for which a daily dose is indicated.**) Note that sometimes instructions are to the side of or below the “box” containing the dosage information.
- Consistently adhere to all obligations of the two- and three-way methadone maintenance therapy agreements that are used.
- Review and follow ACP’s Treatment for Opioid Dependence: Guidelines for Pharmacists and Pharmacy Technicians.
- Confirm rather than assume. Do not assume that because your pharmacy is closed one day a week that you can provide a carry for that day. Do not assume that if patients miss a dose they can have the prescription expiry date extended and use their “extra” carries. Your patient may have a prescription at another pharmacy for that service. Check with the prescriber if you are unsure.
Licensees – ensure that all staff, including any relief (locum) pharmacists, are aware of your methadone policies, especially the requirement to not issue any doses past the prescription expiry date, and know where to check to confirm the prescription information.
Resources:
Best Practices – Methadone Maintenance Treatment, Health Canada
Literature Review – Methadone Maintenance Treatment, Health Canada
Treatment for Opioid Dependence: Guidelines for Pharmacists and Pharmacy Technicians, ACP
