British Columbia is facing dual health emergencies, with the COVID-19 pandemic compounding and escalating the existing opioid overdose crisis, which was declared a public health emergency in April 2016.
The opioid overdose crisis continues to have a major impact on the province. Since the COVID-19 pandemic was declared a public health emergency in March 2020, the BC Coroners Service detected a sustained increase in illicit drug toxicity deaths. In total, 1,716 people died of illicit drug overdoses in 2020, a 74% increase in deaths over 2019. Further to that, an additional 320 people died of illicit drug overdoses in January and February 2021.
February 2021 marked the 11th consecutive month in which the province recorded over 100 overdose deaths.
Acknowledging the marked increase in overdose deaths following the onset of the COVID-19 pandemic, the College worked closely with the Ministry of Health, Ministry of Mental Health and Addictions, and BC Center on Substance Use to respond. The College quickly implemented a number of policy changes and temporary exemptions across British Columbia to support continuity of care for people with substance use disorders during the COVID-19 pandemic.
Changes to The Delivery Requirements for Opioid Agonist Treatment (OAT)
In the context of COVID-19, the College recognized the importance of maintaining British Columbians’ access to controlled substances for medical treatments, including OAT. In March 2020, the College Board approved new delivery requirements for Opioid Agonist Treatment, allowing pharmacists to use their professional judgement to deliver the drugs to a patient if they feel it is safe, appropriate and in the best interest of the patient to do so. As a result, prescribers no longer need to authorize delivery for OAT drugs.
Previously, Professional Practice Policy-71 allowed pharmacists working in community pharmacies to deliver methadone for maintenance to a patient’s home only if the prescribing physician authorized delivery due to the patient’s immobility. These changes aimed to improve access to OAT for patients whose care may benefit from delivery, while ensuring the safety of both the patient and the pharmacist involved.
Given the onset of the COVID-19 pandemic in early March, the College Board decided to accelerate the implementation of these requirements in order to support continuity of care for BC OAT patients.
Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists
Further to the changes to the delivery requirements for OAT noted above, in April 2020, the College also implemented temporary amendments to PPP-71 that allow pharmacists to authorize regulated health professionals to deliver OAT.
These temporary amendments also allowed pharmacists to authorize pharmacy employees, including pharmacy technicians and pharmacy assistants, to deliver OAT on a pharmacist’s behalf in exceptional circumstances where it is not possible for a pharmacist or other regulated health professional to deliver the OAT drug.
These temporary authorizations align with Health Canada’s temporary exemption under the Controlled Drugs and Substances Act (CDSA), to maintain Canadian’s access to controlled substances as needed for medical treatments during the COVID-19 pandemic which includes permitting pharmacy employees to deliver prescriptions of controlled substances to patient’s homes or other locations where they may be (e.g. self isolating).
New Harmonized Controlled Prescription Program Form
In February 2020, the Board approved amendments to the Controlled Prescription Program forms to create a harmonized form.
The Controlled Prescription Program (CPP) is a duplicate prescription program created to prevent forgeries and reduce inappropriate prescribing of drugs listed in Schedule 1A. Prescriptions for drugs specified in the CPP must be written on a duplicate form specifically developed for this purpose.
Prior to these amendments, there were two CPP forms in use, a generic CPP form used for the majority of controlled prescriptions, and a methadone CPP form which is used to prescribe methadone for maintenance treatment.
The College led the development of the new harmonized form in order to increase patient access to OAT therapy. Currently, only OAT prescribers have the methadone CPP form. The new form also reflects the updated OAT delivery guidance. Most notably, the form no longer requires physician authorization for delivery, but rather allows prescribers to specify when delivery is not permitted.
Amendments to Training Deadlines for Opioid Agonist Treatment
In November 2020, the College Board approved amendments to Professional Practice Policy 66: Opioid Agonist Treatment (PPP-66) to extend the deadline for transitioning to the Opioid Agonist Treatment Compliance and Management Program for Pharmacy (OAT CAMPP), from March 31, 2021 to September 30, 2021.
In November 2018, the Board approved amendments to PPP-66 to phase out the College’s Methadone Maintenance Treatment (MMT) training program and transition to the new OAT-CAMPP, developed by the Ministry of Health (Ministry) and the British Columbia Pharmacy Association (BCPhA). PPP-66 initially required that registrants complete the applicable components of OAT-CAMPP by March 30, 2021.
However, in March 2020, the in-person OAT-CAMPP training was suspended due to the sudden onset of the COVID-19 public health emergency.
The BCPhA has now developed an on-line version of OAT-CAMPP. It has been accredited by the Canadian Council on Continuing Education in Pharmacy (CCCEP), and the first OAT training workshops begin on November 20, 2020.
The 6-month training deadline extension was made to recognize the impact of COVID-19 and the temporary suspension of the OAT-CAMMP. Registrants employed in a community pharmacy that provides pharmacy services related to opioid agonist treatment are strongly encouraged to complete the OAT-CAMPP program as soon as practicable.