Joint message from ACP and CPSA regarding s56(1) exemptions
Access to controlled substances
To support access to controlled substances for Canadians who need them for medical reasons (e.g., chronic pain, conditions requiring stimulants, etc.), Health Canada issued temporary exemptions on March 19, 2020, for prescriptions of controlled substances under Section 56 of the Controlled Drugs and Substances Act (CDSA). With respect to controlled substances (including narcotics, controlled drugs, and targeted drugs), effective immediately, the exemptions:
- permit pharmacists to extend prescriptions,
- permit pharmacists to transfer prescriptions to other pharmacists,
- permit prescribers to issue verbal orders (i.e., over the phone), and
- permit pharmacy employees to deliver prescriptions of controlled substances to patients’ homes or other locations where they may be (i.e., self-isolating).
These temporary exemptions were issued in response to the COVID-19 pandemic, to allow patients to receive uninterrupted care while complying with social distancing and self-isolation.
This will impact patient care and how physicians and pharmacists interact with one another when prescribing and dispensing controlled substances. Patient safety and success depends on the effectiveness of pharmacists and physicians working together. As a result, the Alberta College of Pharmacy (ACP) and College of Physicians and Surgeons of Alberta (CPSA) are communicating with their respective members on how to interpret these temporary exemptions and put them into practice.
A collaborative team effort between the pharmacist and physician is always the preferred approach, and is essential to optimizing a patient’s health and meeting their needs. Health Canada’s temporary exemptions allow pharmacists to extend or refill prescriptions, and authorize physicians to provide verbal orders for all controlled substances. As the COVID-19 pandemic stretches healthcare resources, physicians and pharmacists must use their judgement to assess the most appropriate approach and the level of collaboration required for each individual patient and their unique circumstances.
Ideally, physicians will continue to issue prescriptions and fax them to the pharmacy. However, if this is not practical in a particular situation, a verbal prescription from a physician, or a prescription extension by the pharmacist, are now options to consider. Pharmacists should seek to collaborate with physicians and avoid prescribing in circumstances where the patient is unstable, at risk, or requires changes to their regimen.
The TPP Program remains active and prescribers and pharmacists should continue to adhere to the polices outlined in the TPP Alberta Guide, unless doing so puts them or their patients in a position that contravenes the public health advice for social distancing and self-isolation. The temporary exemptions from Health Canada mean prescriptions for type 1 TPP medications that are
- sent by verbal order from physicians and other prescribers, or
- written by pharmacists
will not require a secure TPP form.
As verbal prescriptions bring the risk of errors and diversion, pharmacists should take any steps necessary to authenticate the source of the verbal prescriptions, while physicians should be prepared to provide identifiers such as their license number. For all other circumstances, physicians and other prescribers should make every effort to provide a secure form whenever possible, to prevent diversion and protect the public.
Additional guidance for pharmacists on prescribing controlled substances is available on the ACP website. If you have additional questions or concerns, please contact:
Alberta College of Pharmacy