Methodone Prescribing for Inpatients within RQHR

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Methodone Prescribing for Inpatients within RQHR

25-May-2017

SITUATION

Effective March 17, 2017, the Office of Controlled Substances (Health Canada) has issued a section 56 class exemption which will affect practitioners practicing in a hospital. As of the stated date, practitioners no longer require a temporary methadone s.56 exemption in order to continue the treatment of a patient admitted to a hospital and receiving methadone prior to admission. 

Within this exemption, practitioner is defined as a person who is registered and entitled under the laws of a province to practise in that province the profession of medicine, dentistry, veterinary medicine and nurse practitioner who has not been named in a notice in s.59 of the Narcotic Control Regulations, unless a notice of retraction has been issued under s.60.

The Office of Controlled Substances will no longer provide temporary authorization to hospital prescribers.

The exemption is applicable if the following terms and conditions are met:

Practitioner must:

  1. Be working as a practitioner in the hospital;
  2. Only prescribe methadone to the patient while the patient is in the hospital;
  3. Only prescribe methadone to patients under their professional treatment;
  4. Only prescribe methadone when the methadone is required for a condition for which the patient is receiving treatment;
  5. Only prescribe methadone as an analgesic or for the management of opioid dependence;
  6. Ensure that the regular treating practitioner is informed of the patient hospitalization and coordinate the issuance of methadone prescriptions when the patient leaves the hospital; and
  7. Comply with any terms, conditions or guidelines related to the prescription of methadone set by the practitioner’s provincial licensing body.

The patient must already be receiving methadone treatment prior to their hospitalization. The prescribed methadone must be dispensed by the hospital pharmacy – i.e., no carries.

BACKGROUND

Previously, patients hospitalized on methadone would have methadone prescribed by a physician with a general exemption to prescribe methadone, or a temporary exemption would be obtained (through a practitioner- and patient-specific application and approval process) in order to facilitate the prescription for methadone within the hospital.  Pharmacists and nurses collaborated with the physician to ensure that an authorized prescriber was involved in the care of the patient. This will no longer be done.

ASSESSMENT

All physicians with RQHR privileges will now have the ability to prescribe methadone for inpatients for the purposes of continuation.  It is the responsibility of the prescribing physician to communicate and coordinate methadone prescriptions with the regular treating physician upon patient discharge.

RECOMMENDATION

  1. Pharmacists will honor methadone prescriptions from all RQHR physicians for inpatients.
  2. Nursing units will be made aware that use/administration of carries are not permitted within the hospital; doses must be obtained from the pharmacy department. This will be done through MUSIC.
  3. Physicians to be made aware of this change in practice in accordance with the March 17, 2017 Section 56 Class Exemption issued by the Office of Controlled Substances, Health Canada. This would be done by physician leadership.