2017 NLPB Symposium Recap

This past weekend, the 2017 NLPB Annual Symposium was held at the Hampton Inn & Suites in St. John’s.

It was a great day filled with discussion on important matters facing the pharmacy profession and related to the role of pharmacy professionals in the delivery of health care in the province. The day started on a high note with a very engaging presentation from Janet O’Reilly from the Office of the Information and Privacy Commissioner on the Personal Health Information Act. We hope to have Janet back to deliver more presentations in the future.

Following this, Colleen Simms, Director of Mental Health and Addictions at the Department of Health and Community Serices gave a brief overview of the province’s Opioid Strategy, particularly as it relates to the Take-Home Naloxone program. Colleen was followed by Noelle Patten from the NLPB who gave an overview of the NLPB Guidelines on the Sale of Naloxone in Community Pharmacies as well as a quick recap of some of the recent changes to the Board’s Standards Regarding the Sale of Exempted Codeine Products in Community Pharmacies

At lunchtime, we celebrated the achievements of our registrations with the NLPB Awards Luncheon with the presentation of the following awards:

Canadian Foundation for Pharmacy Past Chair Award Chad Parsons
NLPB Recognition of Service Award Jody Pomeroy
NLPB Certificate of Recognition Barbara Thomas
NLPB Emerald Achievement Award Byron Allen
Pauline Bennett
Deborah Bourne
Mary Byrne
Elizabeth Cater
Susan Gladney-Martin
Catherine Greening
Kenneth Hand
Gary Peckham
Gerald Peckham
Christine Saunders
Leonard Skanes
Gary Skanes
Elaine Tucker
Scott Way

Lunch was followed by an Open Forum during which attendees were given the opportunity to ask questions or bring issues to the Board’s attention. They were also given the opportunity to offer input into the Board’s strategic direction for the next two years. The discussion was very dynamic with great suggestions and constructive feedback offered by the attendees.

The day concluded with the NLPB Annual General Meeting, including an overview of the Board’s activities in 2016. To read more about these activities, please view the NLPB 2016 Annual Report.

Welcoming Natalie Payne

       The Board is pleased to announce the appointment of Natalie Payne to the new position of Legal Counsel. Natalie will act as in-house counsel to the Board and will be responsible for providing a range of legal services and advice in the areas of health policy development, quality assurance programming, and the complaints process, just to name a few. Natalie’s experience as a Crown Attorney and Legal Counsel for the Human Rights Commission, coupled with her keen interest in administrative health law and policy, will be of great value to the Board as we incorporate this new role into the continued expansion of the pharmacy profession in the interest of public safety.

Changes to the Provincial Drug Schedules

Pharmacists are advised that at the May 5, 2017 meeting, the Board approved the following change to the Provincial Drug Schedules:

Moved from Schedule I to Schedule II: “human papillomavirus vaccine”

The updated Guide to the Provincial Drug Schedules and a notice of this change are posted on the Provincial Drug Schedules page of the website.

REMINDER: Buprenorphine-Naloxone Dispensing Requirements

In recent months, NLPB has received numerous questions and concerns from pharmacists and other healthcare providers regarding the prescribing and dispensing of the buprenorphine and naloxone combination product (Suboxone® or generic equivalent). As per the drug product monograph for Suboxone®, buprenorphine-naloxone is approved for the treatment of opioid dependence in adults. The intention of the naloxone component is to deter intravenous misuse. Patients prescribed buprenorphine-naloxone should be carefully monitored within a framework of medical, social, and psychological support as part of a comprehensive opioid dependence treatment program. While buprenorphine-naloxone is generally considered a safer alternative to methadone for treatment of opioid dependence, it is important to note that buprenorphine-naloxone may not be the treatment of choice for all patients, and that concerns about diversion and misuse still exist.

Specifically, NLPB has received many inquiries regarding physician eligibility to prescribe buprenorphine-naloxone. Unlike methadone, an exemption from Health Canada is not required to prescribe buprenorphine-naloxone. However, the expectations of physicians in this regard are outlined in section 3.1.1 of the College of Physicians and Surgeons of NL (CPSNL) “Methadone Maintenance Treatment Standards and Guidelines”, which state:
      Physicians who prescribe buprenorphine shall have the appropriate knowledge, skills, and judgment to do so, including the following:
            a) the physician has taken an educational program on prescribing buprenorphine / Suboxone (i.e. Online Suboxone Education Program www.suboxonecme.ca)
            b) completion of the CAMH Opioid Dependence Core Course (or equivalent program acceptable to CPSNL).
            c) The physician has established a program for the regular testing of patients receiving buprenorphine for drugs of possible abuse; and
            d) ongoing continuing medical education (CME) in opioid-dependency treatment and/or addiction medicine.

Pharmacists are not expected to confirm with an external source that the physician has completed the training requirements of CPSNL related to buprenorphine prescribing. As for all prescriptions, pharmacists must assess the clinical appropriateness of the order at face value, and dispense the product in accordance with NLPB Standards and recognized clinical guidelines, such as the Centre for Addiction and Mental Health (CAMH) “Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guideline”.

PLEASE NOTE: While single entity buprenorphine (supplied as the transdermal patch Butrans®) is indicated for the treatment of pain, the combination therapy buprenorphine-naloxone has not been approved by Health Canada for pain management; therefore, prescribing of buprenorphine-naloxone for pain would be considered “off-label”. Faced with this situation, pharmacists are expected to rely on their knowledge, skills, patient assessment, and professional judgment to act in the best interest of the patient and determine the appropriateness of drug therapy. Supporting documentation for decision-making should be filed in a retrievable manner in the dispensary so that it is easily accessible when required for consultation with other health care providers, NLPB practice site assessments, and audits conducted by Health Canada.

In-line with its approved indication, NLPB Standards for the Safe and Effective Provision of Medication for the Treatment of Opioid Dependence, require that:

  • The pharmacist-in-charge must first apply to the NLPB to register the pharmacy as a site for opioid dependence treatment. Applications will be reviewed and, if approved, authorization will be issued.
  • Pharmacists must apply to NLPB for authorization and provide proof of successful completion of an education program on the use of medication in the treatment of opioid dependence approved by the Board.
  • Pharmacists are expected to assess prescriptions for buprenorphine-naloxone for clinical appropriateness. If pharmacists see doses being prescribed outside of clinical guidelines for buprenorphine-naloxone therapy and NLPB and CPSNL Standards, they should consult with the prescribing physician and document their rationale for deviation in the patient’s record.
  • Pharmacists are required to witness the ingestion of buprenorphine-naloxone. This function may not be delegated to a pharmacy technician, pharmacy student or any other member of the pharmacy team. Pharmacists are to directly observe the patient ingesting the dose.
  • Buprenorphine-naloxone tablets can take 1-10 minutes for the tablet(s) to dissolve completely and pharmacists are expected to ensure that the entire dose has been dissolved and ingested.
  • Administration of doses and provision of take-home doses must be appropriately documented on the patient’s Administration Log.
  • Pharmacists are expected to assess that prescriptions for take-home doses are prescribed in accordance with the criteria and schedules outlined in the Standards. Rationale for deviations from such should be documented in the patient’s record.
  • Take-home doses must be appropriately labelled, include all necessary cautionary labels, and be provided directly to the patient. Pharmacists cannot release take-home doses to an agent designated by the patient to pick up take-home doses on their behalf.
  • Patients should be instructed to return their empty vials with original labels intact to the pharmacy for inspection and destruction and return of vials documented on the patient’s Administration Log.
  • To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website. If there are questions or concerns related to the dispensing of buprenorphine-naloxone, please contact NLPB for guidance.

Research Study

A research study being conducted by the Faculty of Medicine is looking for pharmacists in Newfoundland and Labrador to participate in a short, confidential survey on the use of the HEALTHeNL Viewer. The purpose of this study is to identify what factors pharmacists in the province perceive to be enablers and/or barriers to using the shared electronic health record in practice. Results obtained from this study will help to indicate future educational opportunities, and also identify factors that may influence the direction of EHR upgrades or health policy in the province.

The study is completely voluntary and should only take 10-15 minutes to complete. Your input is valuable, and all data will be kept private and confidential.

If you would like more information or would like to participate, visit the survey page at: https://www.surveymonkey.com/r/9VQVGMH.

This e-newsletter contains information on a wide variety of topics intended to enhance the practice of pharmacy in the province of Newfoundland and Labrador. As it is published and circulated to all registrants on a monthly basis, it is the expectation of the NLPB that all registrants are aware of the matters contained therein.

©2017 Newfoundland & Labrador Pharmacy Board