Frequently Asked Questions from Pharmacy Practice - Summer 2019

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Note that these answers were current at date of publication and are meant as guidance for pharmacy professionals. The College cannot tell a registrant what course of action to take, provide legal advice or opinions, or make any decisions for a registrant.

Q: Does our pharmacy need to notify the College that we are dispensing methadone and/or buprenorphine/naloxone?

ANSWER

The College’s Opioid Policy specifies that pharmacists dispensing methadone for Opioid Agonist Treatment (OAT), also known as methadone maintenance treatment (MMT), must be in compliance with the Fact Sheet: Key Requirements for Methadone Maintenance Treatment (MMT) Dispensing, which states:

Community pharmacies must inform the College within seven days of starting to dispense MMT and of any changes in this information, using the approved Methadone Dispensing Notification Form.

Notification is required to help the College fulfill its mandate to protect the public. All pharmacies undergo routine assessments every one to four years, depending on the activities performed at the pharmacy and the risk of harm those activities pose to the public. A community pharmacy dispensing methadone will be evaluated according to the operational assessment criteria more often than a pharmacy which does not.

Pharmacies dispensing methadone as an opioid analgesic for pain or buprenorphine/naloxone are not required to notify the College.

Q: We have a patient who has been prescribed methadone for pain management. What do we need to have in place before we can dispense this prescription?

ANSWER

The College’s Opioid Policy sets out expectations for pharmacists dispensing all opioids, which includes methadone for pain or analgesia.

Pharmacists should adhere to the most recent clinical practice guidelines and the appropriate standards of practice to ensure best patient outcomes for individuals on opioid therapy. The Opioid Practice Tool provides easy access to numerous resources to support pharmacy professionals in safe opioid dispensing, including the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.

Q: I have received a prescription for buprenorphine/naloxone. Can I dispense it, or do I need to have specific training first?

ANSWER

Guidance from the College with respect to buprenorphine/naloxone dispensing for Opioid Agonist Treatment (OAT) can be found in the Opioid Policy. This includes practicing in accordance with CAMH’s Opioid Agonist Maintenance Treatment: A Pharmacist’s Guide to Methadone and Buprenorphine for Opioid Use Disorder.

Additional resources are available in the Methadone and Buprenorphine Practice Tool and practitioners can access the CRISM National Guideline for the Clinical Management of Opioid Use Disorder via the Opioid Practice Tool.

Although the Opioid Policy does not mandate formal training as a prerequisite for dispensing buprenorphine/naloxone, the College lists Continuing Education opportunities on the OCP website as a tool to assist with professional development.

As with any medication, pharmacists are relied upon to ensure they have the necessary knowledge, skills and judgment to provide OAT in a safe and effective manner.