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Controlled drugs and substances prescribing

10 things NPs should know about controlled drugs and substance prescribing.

posted May 2, 2014

In 2013, CRNBC launched its important regulatory work to support the safe introduction of controlled drugs and substances (CDS) prescribing for NPs. This includes the vital work of the Nurse Practitioner Standards Committee in developing the Standards, Limits and Conditions for Nurse Practitioner Controlled Drug and Substances Prescribing. Since then, we have accomplished a number of key milestones. There is still significant work to be done. A rigorous approach ensures we protect the public while providing clear standards for NPs. We have received a number of questions from NPs and stakeholders. In response, here are 10 things that are helpful to know about CDS prescribing. 

 10 things to know

1. What is CRNBC doing to ensure a safe introduction of controlled drug and substances (CDS) prescribing into NP practice?

In anticipation of provincial regulation that will permit NPs to prescribe controlled drugs and substances, CRNBC’s primary focus is to ensure public safety and protection. Working in consultation with our Nurse Practitioner Standards Committee, NPs, government, educators, employers and the broader health regulatory community, we are developing robust standards, limits and conditions. These standards will guide quality assurance, education, registration and examination requirements. This regulatory responsibility results from the federal New Classes of Practitioner Regulations.

2. If federal legislation makes NPs eligible to prescribe CDS, does this mean NPs in B.C. can prescribe CDS?

No, NPs in B.C. are not currently authorized to prescribe CDS until provincial legislation comes into effect and CRNBC implements CDS Standards, Limits and Conditions. If you’re in doubt whether a certain drug falls into the CDS category, consult the College of Pharmacists of B.C.’s Prescription Regulation Chart (PDF).

3. Why is this regulatory work important to nurse practitioners and the public?

This regulatory work is critical to supporting NPs to safely prescribe CDS. Prescribing CDS requires special considerations and regulatory oversight to keep the public safe. CDS, such as opioids, stimulants, sedatives and tranquilizers, are linked to serious harm (PDF) including addiction, overdose and death. CRNBC takes this very seriously and is collaborating with NPs, other health regulators, educators, employers and experts in this area to establish a strong regulatory framework that successfully addresses such concerns. Read this report (PDF) to learn more about concerns related to the misuse of prescription drugs in Canada.

4. To date, what regulatory work has CRNBC completed and what is left to do?

CRNBC and the Nurse Practitioner Standards Committee in collaboration with NPs and the broader health regulatory community (e.g., government, B.C. health regulators, other jurisdictions, NP educators, employers) has completed a number of steps towards the development of this regulatory work.

What has been completed

  • Literature review and examination of approaches in other jurisdictions
  • Survey, key informant interviews and focus groups with NPs in B.C. 
  • Retained expert consultants for standards and competency development 
  • Ongoing feedback to and revision of draft Standards, Limits and Conditions For Controlled Drugs and Substances Prescribing
  • Regular meetings of NP Standards Committee to develop standards

What is in progress

  • Finalize a statement of competencies
  • Confirm education requirements
  • Quality Assurance Program requirements
  • Registration and exam requirements
  • Considerations related to Early Intervention Program (Health) and Professional Conduct Review
  • Updating CRNBC bylaws
  • Approval of Standards, Limits and Conditions by CRNBC Board
  • Communication, learning and practice consultation resources
5. When will this standard take effect?

It is difficult to predict just how long it will take before these standards, limits and conditions will take effect. What we can say is a revised draft of these standards is anticipated shortly. The College will continue its consultation with the NP community and employers on implementation planning in the coming months. We will keep stakeholders informed of our progress and our anticipated completion date when that becomes available.

6. Why is the process lengthy?

CRNBC is dedicated to best practices and evidence-based regulatory work that provides strong public protection and clear standards for NPs. CDS pose significant risks and require additional prescribing considerations. Read the College of Physician and Surgeons of B.C.’s Principles for Chronic Pain (PDF) to learn more about what to keep in mind. We are taking the necessary time to establish carefully considered standards, limits and conditions. This includes collaboration with experts, NPs, health regulators, government, employers, educators and other stakeholders. This collaborative approach reflects our commitment to relational regulation. Doing this well requires a thorough and rigorous process of discussion, input, review and planning.

7. Is there anything a nurse practitioner needs to do right now in preparation?

NPs should continue to read Nursing Matters for ongoing updates and information about this regulatory work. If you haven’t already done so, you can familiarize yourself with the following:

8. What education or training will be required as a condition for CDS prescribing?

Educational conditions are anticipated, but have not yet been confirmed. CRNBC is consulting with other jurisdictions and will communicate the educational requirement in the coming months.

9. Will NPs have access to PharmaNet?

To comply with these standards, NPs will need access to PharmaNet. CRNBC is collaborating with the Ministry of Health and PharmaNet to address this need. 

10. How will these standards address medical marijuana and methadone?

Initially, these standards will not address medical marijuana and/or methadone. CRNBC is using a phased approach for this regulatory work. In collaboration with other provinces, CRNBC is developing the standards, limits, conditions and other regulatory elements for implementing CDS prescribing. After NPs have acquired experience with CDS prescribing, CRNBC will consider what needs to be in place to address medical marijuana and/or methadone. As part of this work, CRNBC and other Canadian nursing regulators are looking at ways to ensure, whenever possible, that there is a consistent and uniform approach to CDS, medical marijuana and methadone prescribing across the country.

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