Safe Prescribing for Opioid Use Disorder

Under Review: No
Issued by Council: April 1, 2019


  1. For the purpose of this standard, Opioid Agonist Treatment (OAT) refers to full opioid agonist therapies for opioid use disorder treatment.
  2. This standard does not apply to the partial agonist/antagonist buprenorphine/naloxone (Suboxone®).
  3. 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.
  4. A regulated member who INITIATES OAT must:
    1. have successfully completed an OUD workshop/course recognized by the CPSA;
    2. provide evidence of experiential training, supervision, mentorship and/or completion of an approved preceptorship-based course;
    3. hold an active CPSA approval to initiate OAT;
    4. 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;
    5. only initiate OAT for a patient in an appropriate setting with:
      1. access to medical laboratory services and pharmacy services;
      2. 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;
      3. access to Alberta prescription databases (e.g., Alberta Netcare, Pharmaceutical Information Network);
      4. the ability to refer patients to appropriate, multidisciplinary team support (e.g., social worker, addictions counselling); and
      5. other resources and services appropriate to the specific OAT provided;
    6. if transferring OAT maintenance to another prescriber trained and approved to provide OAT:
      1. 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
      2. collaborate with the maintaining prescriber, other regulated health professionals and multidisciplinary team members involved in the patient’s care.
  5. A regulated member who MAINTAINS OAT must:
    1. have knowledge of OAT pharmacology before accepting OAT maintenance for a patient;
    2. have a letter of support and information checklist from the initiating prescriber;
    3. hold an active CPSA approval to maintain OAT;
    4. at minimum, complete an OAT educational module or course recognized by the CPSA within six months of acquiring CPSA approval;
    5. ensure another prescriber approved to maintain OAT is available for continuity of care if the maintaining prescriber is absent or suspends their practice;
    6. collaborate with the initiating prescriber or appropriate delegate, other regulated health professionals and multidisciplinary team members involved in the patient’s care;
    7. access to medical laboratory services and pharmacy services; and
    8. access to Alberta prescription databases (e.g., Alberta Netcare, Pharmaceutical Information Network).
  6. A regulated member who TEMPORARILY prescribes OAT for a patient in an inpatient or correctional facility must:
    1. 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;
    2. restrict OAT prescribing to daily, witnessed doses and not provide take-home doses for unwitnessed use;
    3. 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
    4. collaborate with the community prescriber, other regulated health professionals and multidisciplinary team members involved in the patient’s care at transitions between treatment settings.
  7. Notwithstanding clause 6 subclause (c), regulated members may proceed without consulting the current prescriber if patients require urgent or emergent care.
  8. A regulated member who prescribes INJECTABLE OAT (iOAT) must:
    1. hold an active CPSA approval to initiate or maintain OAT; and
    2. supervise or provide iOAT only within a facility operated by government or a provincial health authority, or a community setting approved by CPSA.

Contact

For archived standards, policies and guidelines:
Chantelle.Dick@cpsa.ab.ca