The updated 2023 provincial OUD guidelines remove the ranking of OAT (i.e., first/second/third-line treatment) and recommends collaborative decision-making based on clinical judgment, client goals and circumstances. Effective November 22, 2023, the College Professional Practice Policies (PPP) – 66 Opioid Agonist Treatment (OAT) and the Policy Guides (Buprenorphine/naloxone, Methadone and Slow-release oral morphine) have been updated to align with the clinical updates in the OUD guidelines.
Summary of the key changes:
| PPP-66 Opioid Agonist Treatment | PPP-66 Buprenorphine/Naloxone Maintenance Treatment | PPP-66 Methadone Maintenance Treatment | PPP-66 Slow-release Oral Morphine Maintenance Treatment |
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2. Methadone Maintenance Policy Statements Includes compounded methadone for patients who have not benefited from documented, reasonable trials of at least two commercially available methadone formulations, or when there is a shortage or no supply of a commercially available methadone formulation. Required references Pharmacies providing MMT services must also maintain most recent version of the Health Canada Policy on Manufacturing and Compounding Drug Products (POL-0051). |
5.1.4 Missed Doses
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3.1 Accepting a Prescription Updated to refer to PPP-66 OAT section 2 which includes compounded methadone as a last resort option or when there is a shortage or no supply of commercially available methadone formulations. 5.2 Missed Doses: If a patient misses 4 or more consecutive days, the prescription must be cancelled, and the prescriber notified. |
3.2 Assessment of a Prescription Removed the requirement for the specific words “For OAT” in the Direction for Use section on the controlled prescription form. 4.1 Releasing a Prescription SROM capsules can be provided whole to be swallowed in witnessed ingestion. Alternatively, the patient and/or prescriber can request for capsules to be opened and pellets sprinkled into cup for immediate ingestion. 5.1 Missed Doses If a patient misses 4 or more consecutive days, the prescription must be cancelled, and the prescriber notified. |
Buprenorphine/naloxone missed doses
As of June 1, 2024, changes to the Missed Dose section in PPP-66 Buprenorphine/naloxone Policy Guide comes into effect and now reflects the most updated BCCSU “A Guideline for the Clinical Management of Opioid Use Disorder” (OUD Guideline) which states the following:
- The dispensing pharmacy is required to cancel the prescription and notify the prescribing clinician if the individual misses:
- 6 consecutive days, without return to full opioid agonist use
- 4 consecutive days, with return to full opioid agonist use
For details, see College webpage Changes to PPP-66 Policy Guide: Buprenorphine/ Naloxone Maintenance Treatment.
Other Policy Guide changes include:
- Updated to include that faxed CPP forms are permitted during public health emergency declared by the PHO, and this includes the Overdose Crisis under the Public Health Act.
- Updated to include that when verbal prescriptions are provided under section 56 exemption to the CDSA, the pharmacy must receive the original or faxed copy of the CPP form from the prescriber as soon as reasonably possible.
- Updated to include that a pharmacist must be present to release OAT prescription to patient, and cannot delegate this to non-pharmacist staff, unless under section 56 exemption to the CDSA.
- Methadone Maintenance Expectation Form and Appendix has been removed.