Dual Health Emergencies: BC’s Opioid Crisis and the COVID-19 Pandemic
While BC continues to respond to the COVID-19 pandemic, it is important that our province’s health professionals recognize that this is not our only health crisis.
The opioid overdose crisis continues to have a major impact on the province. Since the COVID-19 pandemic was declared a public health emergency in March 2020, the BC Coroners Services has detected a sustained increase of illicit drug toxicity deaths, recording six consecutive months with over 100 overdose deaths, three of which saw more than 170 deaths.
“There have been 1,068 illicit drug deaths to date in 2020 in B.C., based on preliminary data. The total number of illicit drug deaths in the first eight months of 2020 have surpassed the total for all of 2019. The number of non-fatal overdose incidents has also increased significantly. BC Emergency Health Services reports close to 7,500 overdose calls throughout B.C. this summer, making it the highest number of overdose calls ever recorded in a three-month stretch.”
Acknowledging the marked increase in overdose deaths over the past few months, the College would like to remind registrants of the following temporary exemptions that are in place to support continuity of care to patients during the COVID-19 pandemic.
Temporary Authorizations for Controlled Drugs and Substances
On March 19, 2020, Health Canada issued a temporary exemption for prescriptions of controlled substances under the Controlled Drugs and Substances Act and its Regulations, in order to support access to controlled substances when needed for medical treatments.
Controlled Drugs and Substances Act - Subsection 56(1) Class Exemption for Patients, Practitioners and Pharmacists Prescribing and Providing Controlled Substances in Canada During the Coronavirus Pandemic.
This temporary exemption:
- Permits pharmacists to extend and renew prescriptions
- Permits pharmacists to transfer prescriptions to other pharmacists;
- Permits practitioners to verbally prescribe prescriptions with controlled substances; and
- Allows an individual to deliver controlled substances to patients (at their homes or an alternate location).
The College Board has amended both the Pharmacy Operations and Drug Scheduling Act (PODSA) Bylaws, as well as the Community Pharmacy Standards of Practice made under the Health Professions Act to align with this exemption.
This exemption expires on the earliest of the following dates:
This exemption may be suspended without prior notice if the Minister of Health deems that such suspension is necessary to protect public health, safety or security. If necessary, the Minister may change the terms and conditions of this exemption. The Minister may also suspend or revoke the exemptions if she believes that it is no longer necessary.
Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists
During the ongoing response to COVID-19, the College recognizes the importance of maintaining British Columbians’ access to controlled substances for medical treatments, including Opioid Agonist Treatment (OAT).
Within the context of dual health emergencies, there has been an increased demand for OAT delivery services, especially for patients who must self-isolate due to COVID-19. BC’s pharmacy professionals must ensure that they are maintaining adequate continuity of care by providing these services safely and in a way that prevents the spread of COVID-19.
As such, temporary amendments to Professional Practice Policy-71: Delivery of Opioid Agonist Treatment (PPP-71) allow pharmacists to authorize regulated health professionals with the appropriate scope and competence, as well as pharmacy employees, to deliver OAT, were introduced on April 7, 2020 and are now in effect.
- Learn More: NEWS - Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists
The temporary amendments allowing pharmacists to authorize pharmacy employees to deliver OAT on a pharmacist’s behalf should be reserved for exceptional circumstances where it is not possible for a pharmacist or other regulated health professional to deliver the OAT drug.
When authorizing a pharmacy employee to deliver OAT, the pharmacist must ensure that the pharmacy employee has the appropriate knowledge and competence to:
- Identify the patient and 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.
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 a pharmacy employee releases the dose.
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.
- FAQ: We are receiving requests for delivery of OAT from patients self-isolating. What are my responsibilities? How do we prevent transmission?
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
- Deliver the controlled substance to the individual identified in the prescription (or to a person designated to accept the delivery on behalf of that individual) 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;
- 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,
- Have the above note as well as a copy of this exemption while effecting the delivery.
For questions related to pharmacy practice, and providing continuity of care for patients during this emergency, contact the College’s practice support at firstname.lastname@example.org.