New Standards for Methadone Maintenance Vol 38 No 4 - Winter 2013 | Jan. 10, 2014 Methadone

The standard concentration of methadone is changing to 10 mg/ml. As a result, signifi cant changes were made to standards and guidelines for Professional Practice Policy 66 (PPP-66) Methadone Maintenance Treatment (MMT).

http://www.bcpharmacists.org/about_us/key_initiatives/index/articles/144...

At the September 20, 2013 Board meeting the Board recognized the significance of these changes and mandated all pharmacy managers, staff, relief pharmacists and pharmacy technicians employed in a community pharmacy that provide pharmacy services related to MMT be required to take the ‘live’ or ‘online’ MMT training session.

On the Road – MMT training
After the approval of the mandatory training College investigator
Dr. George Budd hit the road to begin educating pharmacists and pharmacy technicians who dispense methadone
in a community pharmacy setting. Since the first live MMT training session on September 23, 2013, the College has hosted more than 17 live training sessions, in 14 different cities, traveled over 7500 kilometers and trained more than 1600 pharmacists and pharmacy technicians in BC.

In order to ensure that pharmacists and pharmacy technicians who did not have the opportunity to attend a live MMT training session were still able to meet the requirements, the College developed an online training session, which is available now on the College website.

Pharmacists and pharmacy technicians are encouraged to review the new standards and guidelines again before February 1, 2014.

Timeline for Implementation

By February 1, 2014

All pharmacy managers, staff, relief pharmacists and pharmacy technicians employed in a community pharmacy that provides pharmacy services related to MMT must:

• read the PPP-66 Policy Guide (2013),
• completed the mandatory live or online CPBC MMT
• training program,
• completed their declaration in eServices, and
• implemented all necessary practice requirements identified
• in the PPP-66 Policy Guide (2013).

Transition Period

February 1, 2014 – February 28, 2014:
During this period, pharmacists must:

• transition their patients from 1mg/ml to the commercially available 10mg/ml methadone oral
• preparation,
• obtain new MMT prescriptions from physicians,
• educate patients about safety concerns (eg. 10 times concentration), educate patients about appropriate security and storage (eg. does not require refrigeration and must be stored securely because of increased strength), and manage inventory, create a plan and document appropriate methadone powder return.

Effective

March 1, 2014:

• All methadone maintenance treatment prescriptions must be dispensed with the commercially available 10mg/ml methadone oral preparation.

Delivery of Methadone Maintenance Treatment
The College has introduced a new Professional Practice Policy 71 (PPP-71) Delivery of Methadone Maintenance that prohibits the delivery of MMT. However, 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. There has been a growing concern regarding the delivery of methadone in the province and to address these issues PPP-71 has been put in effect.

Delivery of methadone is now prohibited. The only situation in which delivery may be permitted is if the prescriber identifies that the patient is immobile. The prescriber is required to authorize the delivery of MMT by signing a declaration on the new Methadone Maintenance Controlled Prescription form.

Pharmacists, pharmacy technicians, and patients should be reminded that the distance from a patient’s home to the pharmacy does not qualify as a restriction in mobility.

Pharmacies are not obligated to provide delivery service, but if your pharmacy chooses to provide deliveries you must adhere to PPP-71. As of March 1, 2014 the College will be actively enforcing PPP-71.