Prescribing Methadone practice standard recently updated
The Prescribing Methadone practice standard was recently updated to remove the requirement for mandatory training to prescribe methadone for pain. Registrants who prescribe methadone for pain must be familiar with the standard and the Safe Prescribing of Opioids and Sedatives practice standard.
Registrants are encouraged to regularly review patients’ PharmaNet profiles to ensure safe prescribing of methadone and other opioids. While there are no formal requirements for extra training, registrants who have not prescribed methadone in the past three years are still encouraged to complete the Methadone for Pain in Palliative Care online course, and to read the College’s Methadone for Analgesia Guidelines.
Prescribing methadone has undergone significant change over the last five years, in the world, in Canada, and in BC:
- In 2017, the BC Centre on Substance Use took over much of the activities of the Methadone Program at the College, including providing education for prescribers and writing clinical practice guidelines. The College is still responsible for providing prescribers with their Controlled Prescription Program (duplicate) forms.
- In 2018, Health Canada relieved physicians of the “subsection 56(1) exemption” requirement. Prior to this it was a requirement under the Canadian Drugs and Substances Act (CDSA) that the College request, on behalf of the physician, an exemption to section 56(1) of the Act to permit the physician to prescribe methadone for any indication.
- In 2021, the Controlled Prescription Program Advisory Committee (a committee that the College sits on with the Ministry of Health, and the colleges that regulate pharmacists, dental surgeons, nurses, and veterinarians) changed the controlled prescription pad, creating a harmonized prescription pad. Any controlled (Schedule 1a) drug can be prescribed with this pad, and registrants no longer need a special methadone prescription pad.
As up to 20 per cent of Canadians live with chronic pain, the College believes that pain management is a core competency in the practice of medicine. All registrants providing patient care must be able to manage pain in their patient population and undertake continuous learning on the topic relevant to their practice. Registrants must not abandon patients in need of pain management or discriminate against patients with pain conditions. Methadone can be an effective pain medication, particularly for chronic or palliative pain conditions. By removing formal training requirements and making prescribing methadone simpler, the College hopes that more registrants will prescribe it and enable more patients to receive this important medication.
Prescriptions for analgesic methadone should be written on the new harmonized duplicate prescription form or a regular duplicate prescription form. Registrants’ copies of the duplicate prescription forms should be retained with the patient record (not in the prescription pad) and must be identical to the copies issued to patients.