Ontario s Narcotics Strategy

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1 Ontario s Narcotics Strategy Ontario Public Drug Programs Ministry of Health and Long-Term Care January 31, 2012 Ontario Harm Reduction Distribution Program Conference

2 Background The Need for Action Inappropriate use and abuse of prescription narcotics and other controlled substances is a serious public health and safety issue in Canada, the United States and elsewhere in the world. Issues include: excessive prescribing, escalating misuse, escalating diversion away from intended medical purposes, increases in addictions, increases in narcotics-related deaths Ontario has the highest rate of narcotics use in Canada Since 1991, prescriptions for oxycodone-containing products rose by 900% in Ontario Since 2004, the number of oxycodone-related deaths in Ontario has nearly doubled Recent studies suggest that increased rates of opioid prescribing, particularly long-acting oxycodone, is contributing significantly to morbidity and unintentional opioid-related mortality A number of First Nations communities have declared a state of emergency over the abuse of prescription narcotics, particularly oxycodone-containing drugs 2

3 Background Measures taken by the Ministry Established the Narcotics Advisory Panel in March member multi-disciplinary group with a mandate to provide recommendations to the Executive Officer of Ontario Public Drug Programs (OPDP) on appropriate prescribing, dispensing, and utilization related to opioids and pain management strategies Expertise from professional and regional perspectives, including physicians (family practice, specialists in pain and addiction), pharmacists, the Coroner's Office, professional regulatory bodies and law enforcement Developed a comprehensive narcotics strategy that considers the balance between the availability of narcotics to treat pain and preventing abuse 3

4 Overview of the Narcotics Strategy The Narcotics Strategy is intended to address misuse of prescription narcotics and other controlled substances, and to ensure their safe and appropriate use by patients with medical needs. The Narcotics Strategy aims to: promote awareness of inappropriate prescribing, dispensing and utilization promote appropriate prescribing and dispensing through education develop a proposal to expand treatment and support for addictions to narcotics and controlled substances There are five key elements to the Narcotics Strategy: new legislation to support the development of a narcotics monitoring database partnering with the health care sector to educate on appropriate prescribing partnering with the health care sector to educate on appropriate dispensing education to prevent excessive use of prescription narcotics and controlled substances treatment of addictions 4

5 Enactment of New Legislation A key component of the strategy was the introduction of the Narcotics Safety and Awareness Act, 2010 ("NSAA"). The NSAA and its regulation* will help to support the Government s ability to collect, use and disclose information, including personal health information, that relate to the prescribing and dispensing of prescription narcotic and controlled substance medications in Ontario. The law came into force on November 1, Effective November 1, 2011, the following additional requirements, among others, will be required for a prescription narcotic or controlled substance: For Patients: upon request, must provide an approved form of identification to their prescriber / dispenser to record as appropriate in order to receive a prescription for a narcotic or controlled substance approved forms of identification include health card, driver s licence, certificate of Indian Status, etc. The complete list is available on the ministry website at: spx *Note: Please see Appendix for summary of legislative requirements 5

6 Enactment of New Legislation For Prescribers: Must record all of the following information on the prescription: Identification number of the patient and the type of identification used Registration number on the certificate of registration issued to the prescriber by the College of which he or she is a member Name of the person for whom the monitored drug is prescribed Name, strength (where applicable) and quantity of the monitored drug Directions for use of the monitored drug Name and address of the prescriber Date monitored drug is prescribed The new requirements for prescribers to record on a prescription for a monitored drug their College registration number (e.g., CPSO number) and the patient s identification number and the type of patient identification provided (e.g., driver s licence, Ontario Photo Card, Health Card, etc.) is intended to improve the accuracy and completeness of the prescription information. Exemptions are permitted in limited cases where a patient is unable to provide any of the approved forms of identification. The prescriber should inform the patient that for the exemption to apply, the patient must personally pick up the monitored drug directly from the dispenser at the pharmacy or receive directly through the pharmacy s delivery service, if applicable. The patient cannot use an agent (e.g., family member, friend, etc.) or a third party mail or courier service (e.g., Fed Ex, Kinkos, Canada Post, etc.) to pick up or deliver, as applicable, the monitored drug. 6

7 Enactment of New Legislation For Dispensers: Must keep a record of the information on the prescription, which includes ensuring that the patient identifier is included on the patient s prescription and the prescriber s College registration number Require to record information on persons (agent) who pick up a prescription for a narcotic or controlled substance on behalf of the patient. This information would become part of the existing record-keeping requirements for dispensers and may be audited by the Ministry Once the narcotics monitoring system is implemented in Spring 2012, dispensers will be required to submit the information into the system as directed by the ministry 7

8 Narcotics Monitoring System As part of the strategy, the ministry is developing a narcotics monitoring database to collect information on narcotic prescriptions that are dispensed within Ontario including the private and public sector. The narcotics monitoring system will issue alerts at the time of dispense. Dispensers will use professional judgment to apply appropriate action, such as, do not fill or check with prescribers It is anticipated that the system will be able to identify patterns of inappropriate or excessive prescribing/dispensing, and to implement a province-wide system of alerts when attempts to visit multiple prescribers or visit multiple pharmacies are detected. It will help us target education programs to those areas where there may be a more immediate need due to potential inappropriate use, and make the prescribing, dispensing and use of narcotics and controlled substance medications safer and more secure. Prescribers will not have access to the narcotics monitoring system at this stage of the development. Prescriber access for patient prescription profile is part of the larger Medication Management System initiative. The current technology does not permit either the prescriber or the dispenser to access a patient profile. Other methods may be needed to be considered to facilitate the disclosure of the data that will be collected in the future. Implementation of the system is expected to be implemented in the early Spring Pharmacy systems have started to test their changes to prepare for implementation. The ministry will provide further communications to stakeholders to provide guidance relating to the submission requirements prior to the implementation date of the narcotics monitoring system 8

9 Other Initiatives Other initiatives include: A key component of the strategy is a series of educational initiatives for healthcare providers and the public. A phased approach to the launch of the initiatives has been initiated to allow for a targeted and focused development by leveraging existing resources. To date, the ministry has: provided a compilation of website resources on prescription narcotics and controlled substances for healthcare providers and the public. partnered with CAMH to provide the Addiction and Clinical Consultation Service telephone line for health care providers. The ministry is also working with other partners to ensure that the work for the narcotics strategy will align with the key areas identified in the First Nations Prescription Drug Abuse Strategy Report. This includes the education components as well as the collection of the information through the narcotics monitoring system. Some examples include: funding education workshops for health care providers in areas of the province where greater problems exist Exploring potential changes to formulary listings 9

10 Communications to Stakeholders The ministry has been working with our Communications and Information Branch team to disseminate the information to promote public awareness on the Narcotics Strategy and its new requirements. These include: updating information on the ministry website, including posting questions and answers issuing public notice ads in newspapers across Ontario providing tools, including posters and patient handouts, for health care providers (doctors, dentists and pharmacists) to help them inform their patients about the new requirements. Most health care providers have received the toolkits to date. providing a phone number to the government s ServiceOntario INFOline should people have further questions The ministry is engaging with key stakeholders to discuss the implementation plan and to respond to questions from stakeholders. To learn more about the Narcotics Strategy and the new legislative requirements, please visit the ministry website at: ontario.ca/narcoticsstrategy 10

11 QUESTIONS & ANSWERS 11

12 APPENDIX 12

13 Summary of Legislative Requirements for Monitored Drugs The legislation: Enables the Ministry to collect, use, and disclose information, including personal information and personal health information, that relates to the prescribing and dispensing of monitored drugs in Ontario. Requires prescribers to record specified information on prescriptions for monitored drugs. Requires dispensers to keep a record of specified information with respect to prescriptions for monitored drugs and to ensure that any identity verification requirements set out in the regulations are met prior to dispensing a monitored drug. Requires prescribers, dispensers and operators of pharmacies to disclose information related to prescriptions for monitored drugs to the Ministry as directed by the Ministry. Allows to Minister or the executive officer to disclose information related to prescriptions for monitored drugs to prescribers, dispensers and operators of pharmacies in specific circumstances. Creates offences and establish penalties for non-compliance with the Act. Requires public consultation on any proposed regulations affecting the collection, use or disclosure of personal information or personal health information under the Act. 13

14 Summary of Legislative Requirements for Monitored Drugs The regulation (Ontario Regulation 381/11): requires the prescriber to include an identifying number for the patient on a prescription for a narcotic or controlled substances specifies the information the dispenser must record when dispensing a narcotic or controlled substances specifies the type of identifying number that is acceptable i.e., government issued identification that bears the name of an individual and provides an acceptable level of certainty of the identity of the person the list will be approved by the Minister and posted on the Ministry website requires dispensers to record the name, address and identifier for persons who pick up a narcotic or controlled substance from the pharmacy provides exemptions to allow a prescription to be prescribed and dispensed if patients do not have appropriate identification ensures that all opioids (including those not currently listed in the Controlled Drug and Substances Act (Canada),) are monitored drugs in Ontario exempts prescribers in certain settings such as a hospitals or prisons from the requirements of the Narcotics Safety and Awareness Act, 2010 describes the content of public notices and the method of disclosure that would include: information to be collected, used and disclosed under the Narcotics Safety and Awareness Act, 2010 the purposes for collection, use and disclosure contact information for prescribers, dispensers and public 14

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