BC’s COVID-19 Response: Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists

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BC’s COVID-19 Response

Temporary Authorizations for The Delivery of Opioid Agonist Treatment by Non-Pharmacists

BC's COVID-19 Response

The situation regarding COVID-19 continues to evolve here in BC, Canada and other jurisdictions in the world. The College of Pharmacists of BC is working closely with the Ministry of Health and other partners to support the response to this new illness as part of BC’s health system.

The College will provide any updated information or guidance for pharmacy professionals as it becomes available.

Please follow updates provided on bcpharmacists.org/COVID19

Pharmacy professionals exhibiting COVID-19 symptoms should follow the COVID-19 testing process developed for all British Columbia health care workers.

Temporary amendments to Professional Practice Policy-71: Delivery of Opioid Agonist Treatment (PPP-71) that allow pharmacists to authorize regulated health professionals to deliver Opioid Agonist Treatment (OAT), are now in effect. 

These temporary amendments also allow pharmacists to authorize pharmacy employees, including pharmacy technicians and pharmacy assistants, to deliver OAT on a pharmacist’s behalf in exceptional circumstances where it is not possible for a pharmacist or other regulated health professional to deliver the OAT drug. 

For the health and safety of the public and those involved with delivering medications, if a patient is experiencing symptoms of COVID-19 or is self-isolating, appropriate arrangements should be made prior to delivering OAT. In addition, those authorized to deliver OAT should consider how to maintain physical distancing while delivering medications to a patient.

These temporary authorizations come in response to an increased demand for OAT delivery services, including for patients who must self-isolate due to COVID-19, which has placed considerable strain on BC’s pharmacists. 

The temporary authorizations also align with Health Canada’s temporary exemption under the Controlled Drugs and Substances Act (CDSA), to maintain Canadians’ access to controlled substances as needed for medical treatments during the COVID-19 pandemic which includes permitting pharmacy employees to deliver prescriptions of controlled substances to patient’s homes or other locations where they may be (i.e. self isolating). 

Until now, only pharmacists in BC were permitted to deliver OAT drugs as per the March 17, 2020 amendments to PPP-71.

Temporary Authorizations for Delivery of Opioid Agonist Treatment by Non-Pharmacists

In the context of COVID-19, the College recognizes the importance of maintaining British Columbians’ access to controlled substances for medical treatments, including OAT. As such, College staff have been working with the Ministry of Health to implement solutions, including the use of both regulated health professionals and pharmacy employees to help ensure patients receive their OAT doses.

The following amendments are now in effect.

Regulated Health Professionals 

Pharmacists may now authorize a regulated health professional to deliver OAT, if they have the scope and competence to assess the patient and witness the ingestion of OAT (where required). 

Pharmacy Employees 

Pharmacists may now authorize pharmacy employees to deliver OAT to a patient on the pharmacist’s behalf, however this authorization should be reserved for exceptional circumstances where it is not possible for a pharmacist or regulated health professional to deliver the OAT drug. 

When giving this authorization, the pharmacist must ensure that the pharmacy employee has the appropriate knowledge and competence to provide witnessed ingestion (where required), and to recognize when it may be unsafe to provide the dose to the patient and how they should proceed in these situations. The pharmacist must also ensure the pharmacy employee has the knowledge and competence necessary to identify the patient. 

For guidance on confirming patient identity, see: 

Additionally, PPP-66: Opioid Agonist Treatment Policy Guides require that patients are assessed prior to releasing an OAT dose, and so where possible, a pharmacist should assess the patient by phone or other virtual means before the pharmacy employee releases the dose. 

Documentation 

In addition to the documentation requirements outlined in PPP-71 Delivery of Opioid Agonist Treatment and the PPP-66 Policy Guides, for each delivery, the signature and name of the person authorized to deliver the OAT drug must be documented and retained in the patient record. 

Additional Requirements from Health Canada

The following additional requirements set out by Health Canada’s temporary exemption to the CDSA, must also be met:

(C) Any individual who delivers a controlled substance on behalf of a pharmacist must

  1. Deliver the controlled substance to the individual identified in the prescription (or to a person responsible for that individual’s care) Note: At this time, as per PPP-71 Delivery of Opioid Agonist Treatment, OAT can only be delivered directly to the patient, and cannot be left with any other person;
  2. Obtain in writing a note from the pharmacist identifying the name of the individual effecting the delivery, the name and quantity of the controlled substance to be delivered, and the place of delivery; and,
  3. Have the above note as well as a copy of this exemption while effecting the delivery.
Professional Practice Policy – 71: Delivery of Opioid Agonist Treatment

 

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QUESTIONS

For questions related to pharmacy practice, and providing continuity of care for patients during this emergency, contact the College’s practice support at practicesupport@bcpharmacists.org.

Resources

PRIORITY COVID-19 TESTING FOR PHARMACY PROFESSIONALS

Pharmacy professionals who have symptoms consistent with COVID-19 infection should be following the COVID-19 testing process developed for all British Columbia health care workers.

Apr 07, 2020