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Q&As: Controlled Substances Education Requirement
Since the prescribing of controlled substances is a high risk activity, regulations include a requirement that all NPs must complete approved education before they can prescribe controlled substances.
The following are answers to questions you may have about this education requirement:
What courses can I take?
There are foundational NP programs that have been approved as having integrated controlled substances content.
You can also take one of the following three courses, which were approved by CNO Council:
- Athabasca University’s Prescription and Management of Controlled Drugs and Substances course (this course is offered in English): http://fhd.athabascau.ca/programs/pd/index.php.
- Prescribing Narcotics and Controlled Substances course offered through the University of Ottawa: http://cpd.np-education.ca/. This course is offered in English and French, and is available through the Ontario Primary Health Care NP Program Website: http://np-education.ca/. The version approved by Council was the course University of Ottawa offered on or after January 17, 2014.
- Controlled Drugs and Substances: Essential Management and Prescribing Practices course offered through the University of Toronto. The course is available in English, in various formats. Website: https://bit.ly/ControlledDrugsandSubstances
Do I need to complete the course if I don’t plan to prescribe controlled substances?
All NPs are expected to complete the course to avoid having a restriction placed on Find a Nurse. The course is important for all NPs because the content is broader than prescribing controlled substances. Even if you do not prescribe controlled substances, the course covers content that may be relevant to your current or future practice – for example, information related to federal laws; examples of aberrant behaviour that may indicate misuse, addiction or diversion; misconceptions and client stigmatizations; and, ethical considerations.
More than 80 percent of NPs have met the education requirement and more are in the process.
In the future, competencies to prescribe controlled substances will be part of the education programs for entry into NP practice so all NPs will have these competencies.
What content does the course cover?
Course content is broad and is intended to build on existing NP competencies. Content includes:
- Epidemiology of prescription medication misuse and addiction.
- Jurisprudence related to prescribing controlled substances, including:
- NP authorities and restrictions;
- prescription requirements;
- record retention requirements; and,
- reporting requirements.
- Indications for prescribing, and pharmacotherapy of, various classes of controlled substances:
- benzodiazepines and targeted substances; and,
- controlled drugs (parts I, II and III).
- Evidence-informed strategies that can be used in health assessment, diagnosis and therapeutic management to identify and mitigate medication misuse, addiction and diversion.
- Examples of aberrant behaviour that may indicate misuse, addiction and/or diversion.
- Comprehensive approaches to the treatment plan, which includes:
- establishing evidence-informed rationale for client selection;
- establishing clear treatment goals and measures by which those goals will be assessed;
- considering different modalities, when applicable;
- using evidence-informed strategies for assessing, monitoring and managing risks;
- conducting regular reviews of risks, progress and treatment efficacy;
- considering when and how to alter or discontinue treatment if goals are not met; and,
- identifying indications for consulting or referring to others (e.g., pain specialists, mental health/addictions).
- Poly-pharmacy risks, including high-risk drug combinations involving controlled substances.
- Informed consent from clients for a comprehensive approach to treatment, and tools to support informed consent (e.g., treatment agreements).
- Objective and credible evidence-informed resources to support practice, including links to relevant organizations and tools (e.g., research clearinghouses, evidence-based assessment/screening tools).
- Ethical considerations associated with decisions about when to initiate and discontinue treatment using controlled substances.
- Reinforce the leadership necessary to provide appropriate treatment while managing expectations and dealing with the pressure to prescribe from multiple sources (e.g., clients, employers, other health care professionals).
- Misconceptions and client stigmatizations that may be held by health professionals.
Depending on your practice setting and client population, you may find that you need additional learning and may choose to complete additional, more specific education.
Why does one course reference University of Ottawa and the Ontario Primary Health Care NP Program?
University of Ottawa administers the course. It is also accessible through the Ontario Primary Health Care NP Program Website: http://np-education.ca/.
I noticed on the registration page for Athabasca’s course that they asked me to give them an email address to contact CNO. What email address should I put down?
You are probably referring to the part of the form that says:
If you wish to have us notify your college when you complete this module please complete the following information: Contact email for that College of Registered Nurses in the jurisdiction where you are registered.
You’ll notice that there is no asterisk next to this line in the form – Athabasca does not need this information so you can leave it blank.
What if I successfully complete one of the approved courses and I don’t receive email confirmation from the College that they have received validation from the University?
If five weeks have passed since you successfully completed the course and you have not received email validation from CNO, you can email Customer Service at firstname.lastname@example.org with the following subject line: Successfully Completed Controlled Substances Course. In the body of the email, please include:
- the day you successfully completed the course, and
- whether you completed the Athabasca, University of Ottawa or University of Toronto course.
We will look into this and get back to you.
Please do not email before five weeks (it will take five weeks for CNO to receive the information from the university, enter it in our system and then send you confirmation).
Why is University of Ottawa’s course only approved for on or after January 17, 2014?
The version of the course approved by Council was launched January 17, 2014.
Why would the College accept courses previously taken?
Council approved that NPs would have met the controlled substances education requirement if they completed the courses in the last three years. This is in the public interest as it is supported by findings in the literature related to knowledge retention.
I have not completed the education requirement. When I complete it, will the restriction be removed from the register?
If you complete approved education, the restriction will be removed from the register. This takes about five weeks to process after you've completed the education.
As part of my NP program in another jurisdiction, the curriculum included controlled substances content. Would this satisfy the requirement or do I need to complete one of the two approved courses?
NPs can prescribe controlled substances once they have completed approved controlled substances education. In addition to standalone courses, Council has approved several NP program across Canada as having the required controlled substances content integrated into curriculum. Here’s a complete list of approved NP courses and programs that integrate controlled substances education.
If you completed another program that integrated controlled substances content (i.e. not on the list), you have two choices:
- You can complete one of the Council-approved options.
- If you completed your program in the last three years, CNO could assess the content from your curriculum to see if it meets the requirements. However, this process takes time (this requires collaboration between you, CNO, your school, and then requires Council approval). If you want to explore this as an option, please contact the Entry-to-Practice Team at email@example.com with the following subject line: Need Controlled Substances Curriculum Assessed.
Will CNO cover the cost of the course?
No. CNO will not cover the cost of the course.
I plan to move to another Canadian jurisdiction next year. Will they accept one of the approved courses?
Each jurisdiction sets the requirements for NP practice in their province or territory, so you should contact the nursing regulatory body for that jurisdiction to find out their requirements.
Do I need to complete specific education before prescribing methadone or diacetylmorphine?
Only NPs who have successfully completed College approved controlled substances education are authorized to prescribe controlled substances in Ontario, this includes methadone and diacetylmorphine.
At this time, there is no legal requirement for NPs to complete specific education before prescribing methadone or diacetylmorphine. However, additional resources are available to support NPs continuing competence and clinical decision making. For example the Opioid Dependence Treatment (ODT) Core course is an interprofessional course offered by the Centre for Addiction and Mental Health. This is the same course Ontario physicians are required to take before they prescribe methadone for opioid dependence. Pharmacists are also required to complete education related to dispensing methadone.
CNO Council will be considering if additional educational requirements are needed to support safe practice. Council will take into account public safety issues, existing expectations and what other regulators require.