RELEASING AND DELIVERING METHADONE
Community pharmacists are required to properly store, dispense, counsel, and ensure the appropriate release of methadone. The release of methadone includes providing doses by witnessing or giving carries, and in rare occasions, delivering methadone. Canada’s opioid crisis places focus on the need for following necessary requirements involving all narcotic and controlled medications to prevent diversion and ensure the protection of the public.
Pharmacists are required to abide and adhere to legislation when providing services involving narcotics and methadone. It is always the expectation that pharmacists will practice in compliance with these legislative requirements and use sound professional judgment to make decisions in the best interest of the patient. Some of the legislation with which a pharmacist must comply as it relates to narcotics and methadone are:
- The Controlled Drugs and Substances Act (CDSA) and its regulations;
- the Health Professions Act (“HPA”) and its Bylaws;
- Pharmacy Operations and Drug Scheduling Act (“PODSA”) and its Bylaws;
- Professional Practice Policies (PPP) #66 Methadone Maintenance Treatment; and
- PPP #71 Delivery of Methadone for Maintenance.
Releasing Methadone Prescriptions:
The community pharmacist is always involved in the release of methadone to a patient. This is a task which cannot be delegated. A pharmacist releasing methadone prescriptions may witness the patient’s dose as well as release any authorized carried doses for future days. Principle 4.1 of Professional Practice Policy-66 “Policy Guide Methadone Maintenance Treatment (2013)” details the requirements when releasing a methadone prescription. Specifically, it states that a pharmacist must be present and witness the release of a methadone prescription to:
- Confirm the identity of the patient.
- Assess the competence of the patient (ie. ensure that the patient is not currently intoxicated or otherwise medically impaired).
- Witness the release and ingestion of methadone to the patient, this responsibility cannot be delegated to a pharmacy technician or any other pharmacy support staff.
- Provide appropriate patient counseling.
- If carries are provided, a pharmacist must always witness the first dose of the take-home prescription; all subsequent doses must be dispensed in child-resistant containers with explicit warning label(s).
Delivering Methadone Prescriptions:
In rare occasions, methadone may be authorized by the prescriber for the provision of home delivery. There are times a patient may reside at a hospital in the short-term or a residential home which acts as a temporary residence, but will still require the delivery of methadone services from a community pharmacy.
Regardless of where a patient resides, the release of methadone must be conducted by a pharmacist who performs that delivery, assesses the patient for competence, and witnesses the appropriate dose. The delivery and release of methadone cannot be delegated to a pharmacy technician or any other staff member. The first dose must be a witnessed ingestion with all subsequent carried doses dispensed in individual child-resistant containers with an explicit warning label indicating that the amount of drug in the container could cause serious harm or toxicity if taken by someone other than the patient.
The delivery and witnessed ingestion of methadone must be conducted by a pharmacist. The delivered dose cannot be left to be witnessed by a nurse or any other hospital staff member or care worker at a later time.
Professional Practice Policy-71 (PPP-71) “Delivery of Methadone for Maintenance” states:
Under extraordinary circumstances, if the patient has restrictions in mobility and if the prescribing physician has provided written authorization on the prescription by signing the declaration, pharmacists may provide home delivery of methadone for maintenance. This practice is the exception to the rule and not normal practice.
It is not acceptable for the pharmacist to deliver the methadone to an alternate person or location or to leave the methadone unattended.
If the delivery involves leaving carried doses, the patients should be reminded that methadone should be stored out of the reach of children, preferably in a locked cupboard or small lock box if stored in the refrigerator.
Home Delivery Requirements:
If the delivery of a methadone prescription is authorized by the prescriber, the community pharmacist must meet the following delivery requirements:
- The pharmacist must determine whether home delivery is feasible within the services and resources the pharmacy provides. If the pharmacy does not provide delivery service – it may be appropriate to refer the patient to a pharmacy that can provide the delivery; and
- If the pharmacy is able to provide home delivery services, the pharmacist must work with the patient to provide the home delivery abiding to all legislation and guidelines. This includes a pharmacist witnessing the methadone as required.
Additional Methadone Resources:
Professional Practice Policy #66: Methadone Maintenance Treatment
Professional Practice Policy #71: Delivery of Methadone for Maintenance
A Guideline for the Clinical Management of Opioid Use Disorder - BC Centre on Substance Use