Is there a maximum duration or number of OAT doses permitted for carries?
There are no maximum number of take-home doses for OAT specified in the policy guides, but pharmacists must assess the appropriateness of the quantity dispensed.
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Is it acceptable for prescribers to issue blanket authorizations for carries “on holidays” or “when the pharmacy is closed” for OAT prescriptions?
Prescription authorizations must always be patient-specific, taking into consideration the needs of the individual patient. As such, blanket authorizations applied to more than one patient are not acceptable. The indicated directions on any prescription must always be expressed in a manner that makes the intent of the prescriber clear.
Do the patient and pharmacist need to sign to confirm the release of Opioid Agonist Treatment (i.e. methadone, morphine or buprenorphine for maintenance)?
Yes, prior to releasing the first OAT dose of a prescription, the pharmacist and the patient must sign the Controlled Prescription Program form in the space at the bottom of the form to confirm the patient has received the first dose of the prescription. The patient and pharmacist must also sign the patient/prescription-specific log to acknowledge the receipt of each witnessed ingestion dose, each partial dose and each take- home dose.
Do I have to dispense carries for methadone 10 mg/ml in individual bottles?
Each dose of methadone for opioid agonist treatment must be measured and dispensed in individually labelled, appropriately sized, child resistant packaging with an explicit warning label indicating that the amount of drug in the container could cause serious harm or toxicity if taken by someone other than the patient. It is not acceptable to dispense multiple carries in one container and have the patient measure individual doses at home.
How can I safely and effectively measure small doses of methadone 10mg/ml volume?
The pharmacist must measure the methadone dose using a calibrated device with an error rate of no greater than 0.1ml, which is equal to 1mg. All devices used to measure methadone should be distinctive and recognizable and should be used only to measure methadone solutions. Devices should be labelled with a “methadone only” label and a “poison” auxiliary label with the international symbol of the skull and cross bones. Pharmacists may contact their wholesaler for assistance to locate a product that meets the required specifications.
Does Professional Practice Policy 66 apply to methadone, slow-release oral morphine or buprenorphine/naloxone, when used for pain?
No. PPP-66 sets the standards for dispensing methadone, SROM and buprenorphine/naloxone for opioid agonist treatment only. Prescriptions written for pain management must follow other non-OAT standards and policies.
Can a pharmacist accept a faxed or verbal OAT prescription?
Prescriptions for OAT may only be received by facsimile in accordance with section 7(3) of the Health Professions Act Bylaws Schedule F, Part 1 – Community Pharmacy Standards of Practice. A Controlled Prescription Program (CPP) form can only be accepted by facsimile during a public health emergency declared by the Provincial Health Officer. This includes the ongoing Overdose Crisis declared under the Public Health Act.