Several foundational NP programs have integrated CNO-approved controlled substances content.

You can also take one of the following three courses, which were approved by CNO Council:

1. Athabasca University’s Prescription and Management of Controlled Drugs and Substances course (offered in English only)
2. Prescribing Narcotics and Controlled Substances course (offered in English and French) through the University of Ottawa
3. Controlled Drugs and Substances: Essential Management and Prescribing Practices course (offered in English only) through the University of Toronto. The course is available in various formats.

All NPs are expected to complete the course to avoid having a restriction placed on their profile in Find a Nurse. The course is important for all NPs because, even if you do not prescribe controlled substances, the course covers content that may be relevant to your current or future practice. For example, it includes information related to:

• federal laws
• examples of aberrant behaviour that may indicate misuse, addiction or diversion
• misconceptions and client stigmatizations
• ethical considerations

Course content is broad and is intended to build on existing NP competencies. It includes:

• epidemiology of prescription medication misuse and addiction
• jurisprudence related to prescribing controlled substances including:
  • NP authorities and restrictions
  • prescription requirements
  • record retention requirements
  • reporting requirements
• indications for prescribing, and pharmacotherapy of, various classes of controlled substances
• 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 diversion
• comprehensive approaches to the treatment plan, which include:
  • 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
  • identifying indications for consulting or referring to others (for example, pain specialists, mental health/addictions specialists)
• 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 (such as treatment agreements)
• objective and credible evidence-informed resources to support practice, including links to relevant organizations and tools (for example, research clearinghouses, evidence-based assessment and screening tools)
• ethical considerations associated with decisions about when to initiate and discontinue treatment using controlled substances
• leadership necessary to provide appropriate treatment while managing expectations and dealing with the pressure to prescribe from multiple sources (such as from clients, employers or 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.

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.

This is not a mandatory field on the form. Athabasca does not need this information, so you can leave it blank.

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 cno@cnomail.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, University of Ottawa or University of Toronto course.

We will investigate this and get back to you.

Please do not email before five weeks has passed (it will take five weeks for CNO to receive the information from the university, enter it into our system and then send you confirmation).

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 because it is supported by findings in the literature related to knowledge retention.

When you complete approved education, we will update your status on our public register, Find a Nurse. This takes about five weeks to process after you’ve completed the education.

If you completed a program that integrated controlled substances content but is not on CNO’s complete list of approved NP courses and programs that integrate controlled substances education , you have two choices:

1. You can complete one of the CNO-approved options.
2. If you completed your program in the last three years, CNO could assess the content from your curriculum to see whether it meets the requirements. However, this process takes time. (It requires collaboration between you, CNO and your school, and then requires CNO approval.) If you want to explore this as an option, please contact the Entry-to-Practice Team at enp@cnomail.org with the following subject line: Need Controlled Substances Curriculum Assessed.

No, CNO will not cover the cost of the course.

Each jurisdiction sets the requirements for NP practice in their province or territory. You should contact the nursing regulatory body for that jurisdiction to find out their requirements.

Only NPs who have successfully completed CNO-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 other 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.

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)