Safe Prescribing for Opioid Use Disorder
Under Review: No
Issued by Council: April 1, 2019
- For the purpose of this standard, Opioid Agonist Treatment (OAT) refers to full opioid agonist therapies for opioid use disorder treatment.
- This standard does not apply to the partial agonist/antagonist buprenorphine/naloxone (Suboxone®).
- A regulated member who prescribes OAT must do so in accordance with recognized, evidence-based guidelines and best practices for Opioid Use Disorder (OUD) treatment.
- A regulated member who INITIATES OAT must:
- have successfully completed an OUD workshop/course recognized by the CPSA;
- provide evidence of experiential training, supervision, mentorship and/or completion of an approved preceptorship-based course;
- hold an active CPSA approval to initiate OAT;
- as a condition of CPSA approval, maintain competence in OAT through ongoing, relevant education as part of their mandatory Continuous Professional Development (CPD) cycle, and provide evidence upon request;
- only initiate OAT for a patient in an appropriate setting with:
- access to medical laboratory services and pharmacy services;
- access to at least one other prescriber who is trained and approved to provide OAT, to ensure continuity of care if the initiating prescriber is absent or suspends their practice;
- access to Alberta prescription databases (e.g., Alberta Netcare, Pharmaceutical Information Network);
- the ability to refer patients to appropriate, multidisciplinary team support (e.g., social worker, addictions counselling); and
- other resources and services appropriate to the specific OAT provided;
- if transferring OAT maintenance to another prescriber trained and approved to provide OAT:
- provide the maintaining prescriber with an information checklist and a letter of support for maintaining OAT for the patient, with a copy of the letter to the CPSA; and
- collaborate with the maintaining prescriber, other regulated health professionals and multidisciplinary team members involved in the patient’s care.
- A regulated member who MAINTAINS OAT must:
- have knowledge of OAT pharmacology before accepting OAT maintenance for a patient;
- have a letter of support and information checklist from the initiating prescriber;
- hold an active CPSA approval to maintain OAT;
- at minimum, complete an OAT educational module or course recognized by the CPSA within six months of acquiring CPSA approval;
- ensure another prescriber approved to maintain OAT is available for continuity of care if the maintaining prescriber is absent or suspends their practice;
- collaborate with the initiating prescriber or appropriate delegate, other regulated health professionals and multidisciplinary team members involved in the patient’s care;
- access to medical laboratory services and pharmacy services; and
- access to Alberta prescription databases (e.g., Alberta Netcare, Pharmaceutical Information Network).
- A regulated member who TEMPORARILY prescribes OAT for a patient in an inpatient or correctional facility must:
- prescribe only for the duration of the patient’s stay or incarceration, and may prescribe up to the first 120 hours after discharge/release after notifying the patient’s community prescriber;
- restrict OAT prescribing to daily, witnessed doses and not provide take-home doses for unwitnessed use;
- consult with the patient’s current prescriber or appropriate delegate before making any changes to the OAT prescription, or introducing any new medications with the potential to interact with OAT; and
- collaborate with the community prescriber, other regulated health professionals and multidisciplinary team members involved in the patient’s care at transitions between treatment settings.
- Notwithstanding clause 6 subclause (c), regulated members may proceed without consulting the current prescriber if patients require urgent or emergent care.
- A regulated member who prescribes INJECTABLE OAT (iOAT) must:
- hold an active CPSA approval to initiate or maintain OAT; and
- supervise or provide iOAT only within a facility operated by government or a provincial health authority, or a community setting approved by CPSA.
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