Providing Care for OAT and iOAT Patients Over the Winter Holidays Nov. 30, 2023

PROVIDING CARE FOR OAT AND IOAT PATIENTS OVER THE WINTER HOLIDAYS 

With the winter holidays approaching and many pharmacies adopting holiday hours, it is important for pharmacists to ensure that they are able to accommodate the dosing schedules of patients receiving Opioid Agonist Treatment (OAT). 

The number of unregulated toxic drug injuries and death in BC continues its unprecedented rate of escalation, with 1,836 lives lost to toxic drugs in the first nine months of 2023. These numbers indicate that the province may be on track for the deadliest year yet in the ongoing unregulated toxic drug crisis.  

Following the British Columbia Centre on Substance Use's (BCCSU) Provincial Guidelines for the Clinical Management of Opioid Use Disorder, which were recently updated, Opioid Agonist Treatment - including buprenorphine/naloxone, methadone, and slow-release oral morphine - is provided to many patients at pharmacies across BC. 

Many of these patients require supervised or witnessed dosing, meaning that their prescription requires them to visit their pharmacy in order to both obtain and ingest their daily dose of OAT therapy under the supervision of a pharmacist.

Providing Care to oat patients 

During the winter holidays, contacting prescribers and other health practitioners can be challenging. In situations where a patient’s practitioner cannot be reached to clarify concerns or provide direction, the College expects registrants to use their professional judgment to act in the best interests of their patients and to ensure patients receive safe and accessible treatment.

Registrants should document their intervention, including steps they took to contact the patient’s prescriber, their therapeutic rationale, and plan for follow-up. 

Registrants should also communicate their treatment interventions to the patient’s practitioners as soon as possible and retain proof of this communication.

OAT and Holiday Operating Hours

Under Professional Practice Policy-66: Opioid Agonist Treatment and the Policy Guides for Methadone, Buprenorphine/Naloxone, and Slow Release Oral Morphine Maintenance Treatment, a pharmacy’s hours of service must be consistent with the dosing requirements of the patient.

This means Pharmacists MUST check the start and end dates of a prescription, together with any dosing directions in consultation with the patient to ensure that the patient’s specific needs can be accommodated at their pharmacy BEFORE accepting the prescription. 

For example, a pharmacist would need to ensure that the authorization for dispensing does not end on a day when the patient will not be able to see a prescriber for a new prescription (such as weekends and holidays). They would also need to review the dosing schedule included in the prescription directions (daily witnessed ingestion, take-home doses), including the specific dates and days of the week for each witnessed dose or take-home doses, to confirm that the pharmacy operating hours match the dosing schedule.

While a pharmacist may request a prescriber to write a prescription for carries to accommodate the holiday schedule, they must consider the patient’s needs first. For vulnerable patients, any changes to their normal schedule can be disruptive to their care and may leave them without needed support and monitoring.

If a pharmacy cannot accommodate a patient’s dosing schedule under their holiday operating hours, the pharmacist may refer the patient to another pharmacy or they may consider collaborating with their patients to arrange alternate opening hours on a holiday to ensure that patients receive their prescribed dose.

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

Temporary amendments to Professional Practice Policy-71: Delivery of Opioid Agonist Treatment (PPP-71) that allow pharmacists to authorize regulated health professionals with the appropriate scope and competence, as well as pharmacy employees, to deliver OAT, have been in effect since April 7, 2020. 

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. 

• Learn More: NEWS - Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists

Temporary Authorization 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. 

This temporary exemption: 

• Permits pharmacists to extend and renew prescriptions; 
• Permits pharmacists to transfer prescriptions to other pharmacists; 
• Permits practitioners to verbally prescribe prescriptions for controlled substances; and 
• Allows an individual to deliver controlled substances to patients (at their homes or an alternate location).

The College Board supports the Health Canada temporary exemption through 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.

RESOURCES

• NEWS - Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists
• Extension of Temporary Authorizationis for Controlled Drugs and Substances (CPBC)
• New 24/7 Addiction Medicine Support Line for Pharmacists
• Opioid Agonist Treatment (CPBC)
• Injectable Opioid Agonist Treatment (iOAT)
• BC Center For Substance Use ReadLinks Series
• How to use Naloxone to Save a Life
• COVID-19 Resources (CPBC)