Prescribing: Drugs with Potential for Misuse or Diversion*
Category: Administration of Practice
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
- 2017 Canadian Guidelines for Opioids for Chronic Pain
- Guideline for Prescribing Opioids for Chronic Pain (CDC)
- Nonopioid Treatments for Chronic Pain (CDC)
- Opioid Treatment Agreement Template
- Opioid Manager (McMaster)
- Tapering Opioids for Chronic Pain (CDC)
- The Most Responsible Physician (CMPA)
The CPSA Standards of Practice are the minimum standards of professional behaviour and ethical conduct expected of all physicians registered in Alberta. Standards of practice are enforceable under the Health Professions Act and will be referenced in the management of complaints and in discipline hearings. About the CPSA Standards of Practice