Pharmacy FAQ
Answers
  1. A deceased patient's wife recently brought the patient's unused narcotic medications to my pharmacy. Do I have to obtain authorization from Health Canada before I can destroy these narcotics?

    Yes. When patients return controlled drug substances (including narcotics) to a pharmacist, the pharmacist accepts the legal responsibility for the drug and must, therefore, request a destruction authorization from the Office of Controlled Substances (separately from the pharmacist’s own inventory) before proceeding with the destruction of the controlled drug substances. The pharmacist must record the amount of narcotic / controlled drug to be destroyed, ensure the drugs are rendered unusable and witness the destruction.

    In the case of a deceased patient, the estate executor is the legal guardian of the controlled drug substances. Prior authorization from the Office of Controlled Substances to destroy the controlled drug substances is not required. The drugs should be destroyed in the presence of the estate executor and a pharmacist. A complete and detailed list of the controlled drug substances to be destroyed must be prepared, and the estate executor and the pharmacist must date and sign as witnesses confirming the destruction took place.

    Prior authorization is not required for the destruction of benzodiazepines and other targeted substances.

    Questions about this topic should be directed to the Office of Controlled Substances in Ottawa:

          Telephone – general inquiries:  613-952-2177
          Telephone – compliance, monitoring and liaison:  613-954-1541
          Email:  OCS-BSC@hc-sc.gc.ca

  2. Can a pharmacist accept a faxed prescription for a narcotic or controlled drug to a pharmacy?

    All prescriptions (with the exception of prescriptions for drugs monitored by the Controlled Prescription Program (CPP) formerly called triplicate/duplicate prescriptions) may be faxed to a pharmacy. This includes written and verbal prescriptions written for narcotics and/or controlled drugs. For detailed information, see Bylaw 5-38(2) Facsimile Transmission of Prescriptions.

  3. I have a patient with cancer who wants to receive medical marijuana. What does the patient need to do to?

    The patient must apply to Health Canada's Office of Cannabis Medical Access. Application forms are available online at Medical Use of Marihuana, by telephone toll-free 866.337.7705, or by mail:

    Office of Cannabis Medical Access
    Drug Strategy and Controlled Substances Programme
    Healthy Environments and Consumer Safety Branch
    Health Canada
    Address Locator 3503B
    Ottawa, Ontario K1A 1B9

  4. Can a pharmacist accept a prescription for a controlled prescription (formerly called triplicate/duplicate) drug written by an out-of-province physician?

    Yes and no. In certain emergency situations, a pharmacist can receive a prescription for a controlled prescription drug from an out-of-province physician that's not on the "approved" form. In these situations, as with any emergency, you should use your professional judgment as to whether you dispense the prescription or not. You can base your decision on the medical condition of the patient and surrounding circumstances.

    However, it's your responsibility to make sure the prescription is legitimate and the physician is licensed to practise medicine in Canada. It may be reasonable for some patients, for example those who live close to the B.C./Alberta border, to have a physician in Alberta, and their pharmacy in B.C. In those cases, it may be appropriate to continue to dispense a controlled prescription from outside of B.C.

    In most other circumstances, however, if a particular patient makes a habit of asking you to dispense prescriptions for controlled prescription drugs written by out-of-province physicians, you should refer the patient to a physician licensed to practise in B.C. You should not continue to dispense the prescriptions.

  5. A patient brought in a prescription for two drugs, Amoxil® and Tylenol with Codeine No.3®, written on the same prescription form. The patient only wants me to dispense one of these drugs and wants another pharmacy to dispense the other drug. What do I need to do?

    The process you need to follow is different, depending upon which drug you dispense.

    Amoxil® dispensing (non-narcotic) - you need to return the original prescription to the patient:

    • Process the prescription for Amoxil®.
    • On the original prescription, indicate that you have dispensed the Amoxil® and note your pharmacy name, your initials, and the date.
    • Photocopy the original prescription for your records.
    • On the photocopy, make a note that the original prescription was returned to the patient.
    • Return the original prescription to the patient. The patient can then have the undispensed narcotic prescription dispensed at the pharmacy of his/her choice.

    Tylenol with Codeine No.3® dispensing (narcotic) - you need to keep the original prescription:

    • Process the prescription for Tylenol with Codeine No.3®.
    • Log the prescription for Amoxil®.
    • Photocopy the original prescription for your records.
    • On the original prescription, indicate that you have dispensed the Tylenol with Codeine No.3® and logged the Amoxil®. Note your pharmacy name, your initials, and the date.
    • You may photocopy the original prescription and provide the photocopy to the patient. Be sure to note your pharmacy name and telephone number on the photocopy so that the other pharmacy can contact you to transfer the Amoxil® prescription.

     

  6. We were working on a prescription for 100mL of Tussionex suspension. As the technician was attaching the label to the bottle, it tipped over and the contents spilled onto the counter and floor. What should I do?

    As required by the Regulations to the Controlled Drugs and Substances Act, you should report the loss (or theft) of controlled drugs and substances directly to the federal Office of Controlled Substances within ten days of discovery. You can order loss and theft reporting forms from:

    Compliance, Monitoring and Liaison Division
    Office of Controlled Substances
    Health Canada
    Address Locator: 3502B
    Ottawa, Ontario K1A 1B9

  7. What is the proper way of documenting part-fills for controlled drugs and substances (including narcotics)?

    In the past, Health Canada has expected pharmacists to document part-fills of controlled drugs and substances (including narcotics) by recording the quantity dispensed on a given date on the reverse side of the original prescription, along with the handwritten initials of the pharmacist responsible for dispensing the part-fill. In addition, a "paper trail" copy of the prescription, for information purposes, had to be included in the daily prescription file on each part-fill date.

    Health Canada is now determined that the software commonly used in community pharmacies in British Columbia has automated many recordkeeping functions. It is now not necessary to add part-fill documentation to original prescriptions when a second and subsequent part-fill is processed, provided that the software program allows tracking between the part-fills (quantity, date, prescription number) and the original prescription. A "paper trail" copy of the prescription must continue to be filed in the daily prescription file on each part-fill date.

    In the case of methadone prescriptions, pharmacists may continue to document each part-fill on the reverse side of the original prescription. A "paper trail" copy filed on each part-fill date is not required for methadone part-fills.