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Q&As: Regulations and by-law changes
On April 19, 2017, government approved regulations to expand NPs’ scope of practice to include prescribing controlled substances.
On March 8, Council approved by-law changes to enable the College to post and remove information about prescribing and managing controlled substances on an NP’s profile on the College’s public Register, Find a Nurse. This ensures that the public, employers, other health care providers and stakeholders can find out whether an NP is authorized to prescribe controlled substances.
The information that will be posted on an NP’s profile depends on:
if they have met the education requirements as defined in the regulation
if there is a Health Canada notice about the NP
The following are answers to questions you may have about the proposed regulation and by-law changes:
Can all NPs prescribe controlled substances?
Only NPs who have successfully completed College approved controlled substances education are authorized to prescribe controlled substances in Ontario. For more information about the education, read Q&As: Controlled Substances Education Requirement.
Are there any controlled substances that NPs can’t prescribe?
Yes, regulations under the federal law prohibit NPs from prescribing the following controlled substances:
opium (such as opium and belladonna suppository)
coca leaves (such as cocaine) and
anabolic steroids except testosterone (NPs are authorized to prescribe testosterone.)
Also, NPs in Ontario can only prescribe methadone with a Health Canada exemption (see next question for details).
Can NPs prescribe methadone?
Methadone is regulated more rigorously than other controlled substances. A Health Canada exemption is required to prescribe it. At this time, there is no process for individual NPs to obtain this Health Canada exemption.
However, there is one exception. If specific terms and conditions are met, there’s an exemption that allows prescribers (such as physicians and NPs) working in hospitals to prescribe methadone to clients who are admitted to hospital and who have a prior methadone prescription. If an NP is prohibited from prescribing controlled substances, they cannot prescribe methadone under this exemption.
Details of the mandatory terms and conditions are in Health Canada's Section 56 class exemption for practitioners prescribing methadone to inpatients in a hospital setting.
Not meeting these terms and conditions may result in a contravention of the Controlled Drugs and Substances Act and its regulations.
In addition to the terms and conditions, NPs are expected to meet the accountabilities outlined in the Nurse Practitioner practice standard and ensure they have the competence to prescribe methadone.
It seems punitive to place a restriction on the register. Why is the College taking this approach?
Prescribing controlled substances is a high-risk activity. Meeting the controlled substances education requirement gives NPs competencies related to safe, effective and ethical prescribing, and managing clients who are treated with controlled substances. It is important that anyone can see if an NP has not met the education requirement and is therefore is not authorized to perform this activity. The restriction on the College's public register, Find a Nurse, will be clearly described as follows: "This member cannot prescribe controlled substances. They have not completed the education needed to do so."
More than 80 percent of NPs have met the education requirement and more are in the process.
What are Health Canada notices?
The notice is a letter sent by Health Canada to inform pharmaceutical companies and pharmacies that they must not:
- sell or provide a controlled substance to a practitioner; and/or,
- fill a practitioner’s prescription for a controlled substance(s).
A practitioner is any health care provider with these authorities (e.g., physicians and NPs). The notice is also sent to the relevant regulator (e.g., The College of Nurses of Ontario).
There are several triggers for a Health Canada notice including, but not limited to, if the College requests it because the nurse practitioner breached a rule of conduct or is found guilty of a designated drug offence or an offence under the federal regulations. Details about the notice is posted to the NP's profile on Find a Nurse.