As of May 2018, Health Canada no longer requires methadone prescribers to obtain a federal exemption under section 56 of the Controlled Drugs and Substances Act, and that oversight now lies with the various provincial regulators. In the May 16, 2017 issue of the Link we advised that when receiving a prescription for methadone from an Alberta physician, pharmacists should continue to contact the College of Physicians and Surgeons of Alberta (CPSA) at 780-423-4764 or 1-800-561-3899 or email email@example.com to confirm that the physician has the required approval through CPSA to prescribe methadone. An exception to this however, is that physicians working in-hospital do not require CPSA approval to maintain patients already taking methadone. Further information about the requirements for physicians prescribing opioid agonist therapy is summarized here on the CPSA website.
Although nurse practitioners (NPs) have been authorized to prescribe narcotics and controlled drugs since 2015, the College and Association of Registered Nurses of Alberta (CARNA), only recently approved changes to their Prescribing Standards for Nurse Practitioners (2018) that allow them to prescribe methadone. NPs are not required to apply to CARNA for an authorization to prescribe. Rather, they must complete education and preceptorship appropriate to the area of their prescribing, and will only submit proof of this to CARNA on request.
This means that if pharmacists receive a prescription from an NP for methadone, suboxone, or any other narcotic or controlled substance, they can check the nurse practitioner’s prescriber list on the ACP website. As long as the prescriber is licensed and does not have a condition on their licence restricting them from prescribing controlled drugs and substances, the pharmacist can dispense the medication. As with any medication, if the pharmacist assesses that there is a concern or problem with the prescription, they should contact the prescriber and collaborate to clarify and resolve the issue.
For any out of province prescriptions, pharmacists should contact the appropriate regulatory body in the prescription’s province of origin as regulations vary by jurisdiction and profession.