PROVIDING CARE FOR OAT PATIENTS OVER THE HOLIDAYS
With the holidays approaching and many pharmacies adopting shortened 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 Opioid Overdose Crisis continues to be a major health concern in BC, with over 1140 opioid overdose deaths reported in BC during January to September 2018.
Following the Provincial Guidelines for the Clinical Management of Opioid Use Disorder introduced in 2017, 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 methadone under the supervision of a pharmacist.
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 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.
Note: Methadone, Buprenorphine/naloxone, and Slow release oral morphine prescriptions can only be accepted when written using an original Controlled Prescription Program form. When accepting a prescription, the pharmacist must ensure that the Controlled Prescription Program Form is completed by the prescriber as outlined in the Controlled Prescription Program.
For more information on the requirements around ensuring continuity of care for patients receiving Opioid Agonist Treatment, see the College’s Policy Guides:
- PPP-66 Policy Guide: Buprenorphine/Naloxone Maintenance Treatment (2018)
- PPP-66 Policy Guide: Methadone Maintenance Treatment (2013)
- PPP-66 Policy Guide: Slow Release Oral Morphine Maintenance (SROM) Treatment (2018)
- Opioid Agonist Treatment (CPBC)
- Methadone Maintenance Treatment (CPBC)
- A Guideline for the Clinical Management of Opioid Use Disorder (BCCSU)
- Webinar: Provincial Guidelines for the Clinical Management of Opioid Use Disorder (BCCSU)
- BC Center for Substance Use Education and Training
- Did you know? Buprenorphine/Naloxone (BCCSU)
- Did you know? Slow-release oral morphine (BCCSU)
- Frequently Asked Questions Buprenorphine/Naloxone Treatment (BCCSU)
- BC Center For Substance Use ReadLinks Series
- How to use Naloxone to Save a Life
- New Opioid Agonist Treatment Training Requirements Coming Soon