NEW Opioid Stewardship Spotlight! Meet Tim Smith, president/pharmacist/consultant at Blue Spruce Ventures.
What is CPHS 2020?
There is emerging evidence supporting the health benefits to patients of pharmacist-delivered health care services, however, their scope of practice (unlike other healthcare professionals) is not harmonized across Canada.
That’s why the Canadian Pharmacists’ Harmonized Scope (CPHS) 2020 was launched in 2017 as an initiative which aspires to define, describe and develop a national, forward-looking harmonized scope of practice as well as describe patient benefits delivered by pharmacists working to full scope.
Initial work involved extensive stakeholder consultations resulting in the development of four key domains that would improve patient care and contribute to health care efficiencies — prescriptive authority, dispensing authority, medication administration authority and health test authority.
As work continued it became clear that there were challenges with such a broad review and evaluation of evidence across the four domains of pharmacist-delivered services.
For this reason, CPHS 2020 refocused its efforts — moving from a broad-based scope initiative to a more focused approach in specific therapeutic areas.
CPHS 2020 Steering Committee
CPHS 2020 has a Steering Committee whose purpose is to provide information, advice and recommendations to map the way forward to achieve a harmonized scope of practice for pharmacists within identified therapeutic areas across Canada.
The mandate of the Steering Committee is to provide guidance on the integration of the CPHS 2020 framework which identifies the value of pharmacist-delivered services across the four domains into the broader health system.
- Review evidence provided by the Evidence Groups about health and system benefits to build a strategy for the development of advocacy initiatives;
- Provide input and advice on knowledge translation initiatives, as they relate to the identified therapeutic areas to ensure they meet the needs of the pharmacy community; and
- Be ambassadors within respective jurisdictions of the CPHS 2020 framework among all relevant stakeholder groups.
The Committee reports to and takes direction from the CPhA Board of Directors.
Current CPHS 2020 Projects
Pharmacists Opioid Stewardship Initiative (POSI)
What it is
This project focuses on the scope enhancement and harmonization that enables pharmacists to be opioid stewards.
The Pharmacists’ Opioid Stewardship Initiative (POSI) is a multi-year initiative. It involves synthesizing evidence demonstrating the value of pharmacists’ services in opioid stewardship to both patients and the health system across the four domains of scope of practice authority. The POSI vision: Pharmacists are fully enabled to meet patient and health system needs as opioid stewards universally across Canada.
Armed with this evidence, the profession will be in a better position to advocate governments for harmonized scope of practice for pharmacist services in opioid therapy management for their patients.
The goal is to use POSI as a model for future phases of CPHS 2020 work – taking a patient and health system needs approach to identify subsequent areas of focus.
Why it matters
The opioid epidemic is one of the most challenging and complex health crises in Canada today. According to the federal government, more than 15,000 Canadians have been killed by opioids over the last four years and close to 20,000 people have been hospitalized for opioid-related poisoning. For this reason, POSI is a relevant and timely project which could further help vulnerable Canadians manage their opioid therapy.
Why pharmacists and opioid stewardship
Pharmacists are in an ideal position to be opioid stewards as they are the most accessible health care provider and could fill a critical system gap.
They are often the first health care provider to observe signs of opioid use disorder. Many are already helping patients by optimizing patients’ opioid therapy through pain assessment, medication reviews, monitoring for interactions, medication administration, exemptions for prescribing suboxone and methadone, ensuring appropriate dosing, and consulting on switching or tapering of opioids.
As well there is a considerable existing and emerging evidence base, with existing criteria and a validated framework to guide an evidence review.
CPhA has been a strong advocate for more opportunities and supports for pharmacists in the management of opioid therapy, including expansion of scope of practice for prescribing and adapting opioids and other substances.
COVID-19 pandemic temporary exemptions have been made under the Controlled Drugs and Substances Act (CDSA), creating an opportunity to provide continuity of care to some of our most vulnerable Canadians to ensure that their care is not interrupted, especially in times where they may be experiencing more stress, anxiety and isolation.
These exemptions permit pharmacists to care for their patients by extending prescriptions, transferring prescriptions to other pharmacists, receiving verbal orders and allowing other pharmacy employees to deliver prescriptions of controlled substances to patients’ homes or other locations where they may be. In some provinces, pharmacists are also now permitted to adapt (i.e. modify the dosage, formulation or regimen) prescription-controlled drugs and substances to help in the care of their patients. One of the immediate goals of the POSI initiative is to ensure these temporary exemptions for pharmacists prescribing are made permanent.
How is POSI structured?
POSI has an Opioid Group whose mandate is to build, disseminate and mobilize the evidence for pharmacists in the area of opioid stewardship. Some of the Opioid Group's activities include:
- Scoping review
- Qualitative review
- Consensus framework informed by the two reviews mentioned above, with added consensus from evidence and practice subject matter experts in this area
- Advising CPhA on POSI and synthesizing existing evidence in the area of pharmacist opioid stewardship
- Key Takeaways from the Virtually Together webinar, Pharmacists as opioid stewards: A showcase of the evidence
- Pharmacists as opioid stewards: A showcase of the evidence (Webinar recording)
- Pharmacists’ Harmonized Scope 2020 To Focus on Opioid Stewardship
- Opioid Stewardship Under the New CDSA Exemptions (May 7, 2020)
- Pharmacists’ Scope of Practice Across Canada
- CDSA Scope of Practice chart
- CPhA Opioids page
- Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system (Published in Pharmacy Practice)
- The role of pharmacists in opioid stewardship: Protocol (Published in Research in Social and Administrative Pharmacy)
- Pharmacists advocating for permanency of CDSA exemption (Subscriber access only from Canadian Healthcare Network)
- What Can Pharmacists Do Under the Controlled Drugs and Substances Act (CDSA) During the COVID-19 Pandemic? CPhA developed a series of practice tools to support pharmacists in their role as opioid stewards, using real-life provincial examples to show how pharmacists can manage opioid-related prescriptions under current CDSA exemptions to better care for vulnerable patients.
Health Canada: Controlled Drugs and Substances Act (CDSA)
- Prescription management by pharmacists with controlled substances under the Controlled Drugs and Substances Act and its regulations
- Subsection 56(1) class exemption for patients, practitioners and pharmacists prescribing and providing controlled substances in Canada during the coronavirus pandemic
- Exemptions FAQ
- Government of Canada: Opioid related harms in Canada
- Health Canada: Helping people who use substances during the COVID-19 pandemic
- Health Canada Toolkit: COVID-19 and substance use