Prescribing: Drugs with Potential for Misuse or Diversion*
Under Review: No
Issued by Council: April 1, 2017
- A regulated member must be able to justify prescribing decisions with documentary evidence of a patient’s initial assessment and reassessments as required, including when accepting the transfer of care of a patient from another healthcare provider.
- At the time of initial assessment, a regulated member must discuss and determine with the patient the best medication choice considering the:
- efficacy of other pharmacological and non-pharmacological treatment options;
- common and potentially serious side effects of the medication; and
- probability the medication will improve the patient’s health and function.
- A regulated member must review the patient’s medication history from the Pharmaceutical Information Network (PIN)/Netcare or from an alternative, independent source (e.g., Triplicate Prescription Program, community or hospital pharmacist):
- before initiating a prescription;
- before renewing a prescription, unless the regulated member is the primary prescriber; and
- at minimum, every three months when the prescription is for the long-term treatment of a patient.
- Notwithstanding clause (3), if PIN/Netcare is inaccessible and the patient’s medication history is not available from an alternative, independent source, a regulated member may prescribe the minimum amount of medication required until such information can be obtained.
- A regulated member who prescribes long-term opioid treatment (LTOT) for a patient with chronic pain, exclusive of treatment for active cancer, palliative or end-of-life care, must also:
- establish and measure goals for function and pain for the patient;
- evaluate and document risk factors for opioid-related harms and incorporate strategies to mitigate the risks;
- prescribe the lowest effective dose and, if prescribing a dose that exceeds the opioid prescribing guidelines endorsed by the Council of this College, carefully justify the prescription and document the justification in the patient record;
- at minimum, re-assess the patient within four weeks of initiating LTOT and every three months thereafter;
- document the status of the patient’s function and pain at each reassessment; and
- continue to prescribe LTOT only if there is measurable clinical improvement in function and pain that outweighs the risks of continued opioid therapy.
*Includes, but is not limited to, opioids, benzodiazepines, sedatives and stimulants.
Advice to the Profession
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