Canadian Pharmacists' Harmonized Scope 2020 to focus efforts on pharmacist opioid stewardship

Canadian Pharmacists Association launches Pharmacists’ Opioid Stewardship Initiative as first focus area for CPHS 2020

June 10, 2020

The Canadian Pharmacists’ Harmonized Scope (CPHS) 2020, the CPhA initiative that aspires to define, describe and develop a national, forward-looking harmonized scope of practice for pharmacists, is focusing its efforts on a specific, and very timely, therapeutic area with the launch of the Pharmacists’ Opioid Stewardship Initiative (POSI).

This multi-year initiative will gather evidence to demonstrate the value of pharmacists’ services and benefits to patients in opioid stewardship in 4 domains of scope of practice authority identified in the initial work of CPHS 2020: prescribing, dispensing, health testing and administrative authority. Armed with this evidence, the profession will be in a better position to advocate with governments for harmonized scope of practice for pharmacist services in opioid therapy management for their patients.

The opioid epidemic is one of the most challenging and complex health crises in Canada today. More than 14,000 Canadians have been killed by opioids over the last 4 years, and close to 20,000 people have been hospitalized for opioid-related poisoning.

“Pharmacists are the most accessible health care providers and could fill a critical system gap. They are often the first health care provider to observe signs of opioid use disorder,” says Shelita Dattani, director of practice development and knowledge translation at CPhA. “Many are already helping 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.”

CPhA has been a strong advocate for more opportunities and supports for pharmacists in the management of opioid therapy. This includes listing pharmacists as practitioners within the Controlled Drugs and Substances Act (CDSA), which would expand pharmacists’ scope for prescribing and adapting opioids for their patients.

“Because of the COVID-19 pandemic, temporary exemptions have been made under the CDSA, creating an opportunity to provide continuity of care to some of the most vulnerable Canadians and helping us ensure that their care is not interrupted, especially in times where they may be experiencing more stress, anxiety and isolation,” says Dattani.

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.

“To achieve success for this initiative we have a plan focusing on solid communication and strong engagement from our pharmacy community and beyond so that we can all be ambassadors for full harmonized scope of practice to improve the health of Canadians,” says Dattani.

This work involves engaging the pharmacy community, other health care providers, patients, the public and governments about how the work of the POSI can meet their needs.  Dattani says this initiative —  and its foundational elements of evidence, tools and resources — will support and enable national and provincial efforts to extend, expand and harmonize scope of practice across the country with respect to the exemptions under the CDSA, including the ability to adapt prescriptions.  The work of CPHS POSI will also identify other areas where pharmacists can make an impact in patient care.

“Our goal is to use the Pharmacists’ Opioid Stewardship Initiative as a model for future phases of CPHS 2020 work — taking a patient and health system needs approach to identify subsequent areas of focus,” says Dattani.