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Q&As: Controlled Substances Education Requirement

On December 7, 2016, Council approved that draft regulations enabling Ontario NPs to prescribe controlled substances be sent to nurses and stakeholders for feedback.

Since the prescribing of controlled substances is a high risk activity, the proposed regulations include a requirement that all NPs must complete approved education before they can prescribe controlled substances.

The following are answers to questions you may have about this education requirement:

What courses can I take?

You can take one of the following two courses, which were approved by CNO Council:

  1. Athabasca University’s Prescription and Management of Controlled Drugs and Substances course (this course is offered in English): http://fhd.athabascau.ca/programs/pd/index.php.
  2. Prescribing Narcotics and Controlled Substances course offered through the University of Ottawa: http://cpd.np-education.ca/. This course is offered in English and French, and is available through the Ontario Primary Health Care NP Program Website: http://np-education.ca/. The version approved by Council was the course University of Ottawa offered on or after January 17, 2014.

Do I need to complete the course if I don’t plan to prescribe controlled substances?

Subject to the regulations being approved, all NPs are expected to complete the course to avoid having a restriction placed on Find a Nurse. The course is important for all NPs because the content is broader than prescribing controlled substances. Even if you do not prescribe controlled substances, the course covers content that may be relevant to your current or future practice – for example, information related to federals laws; examples of aberrant behaviour that may indicate misuse, addiction or diversion; misconceptions and client stigmatizations; and, ethical considerations.

In the future, competencies to prescribe controlled substances will be part of the education programs for entry into NP practice so all NPs will have these competencies.

What content does the course cover?

Course content is broad and is intended to build on existing NP competencies. Content includes:

  • Epidemiology of prescription medication misuse and addiction.
  • Jurisprudence related to prescribing controlled substances, including:
    • NP authorities and restrictions;
    • prescription requirements;
    • record retention requirements; and,
    • reporting requirements.
  • Indications for prescribing, and pharmacotherapy of, various classes of controlled substances:
    • narcotics;
    • benzodiazepines and targeted substances; and,
    • controlled drugs (parts I, II and III).
  • Evidence-informed strategies that can be used in health assessment, diagnosis and therapeutic management to identify and mitigate medication misuse, addiction and diversion.
  • Examples of aberrant behaviour that may indicate misuse, addiction and/or diversion.
  • Comprehensive approaches to the treatment plan, which includes:
    • establishing evidence-informed rationale for client selection;
    • establishing clear treatment goals and measures by which those goals will be assessed;
    • considering different modalities, when applicable;
    • using evidence-informed strategies for assessing, monitoring and managing risks;
    • conducting regular reviews of risks, progress and treatment efficacy;
    • considering when and how to alter or discontinue treatment if goals are not met; and,
    • identifying indications for consulting or referring to others (e.g., pain specialists, mental health/addictions).
  • Poly-pharmacy risks, including high-risk drug combinations involving controlled substances.
  • Informed consent from clients for a comprehensive approach to treatment, and tools to support informed consent (e.g., treatment agreements).
  • Objective and credible evidence-informed resources to support practice, including links to relevant organizations and tools (e.g., research clearinghouses, evidence-based assessment/screening tools).
  • Ethical considerations associated with decisions about when to initiate and discontinue treatment using controlled substances.
  • Reinforce the leadership necessary to provide appropriate treatment while managing expectations and dealing with the pressure to prescribe from multiple sources (e.g., clients, employers, other health care professionals).
  • Misconceptions and client stigmatizations that may be held by health professionals. 

Depending on your practice setting and client population, you may find that you need additional learning and may choose to complete additional, more specific education. 

Why does one course reference University of Ottawa and the Ontario Primary Health Care NP Program?

University of Ottawa administers the course. It is also accessible through the Ontario Primary Health Care NP Program Website: http://np-education.ca/.

I noticed on the registration page for Athabasca’s course that they asked me to give them an email address to contact CNO. What email address should I put down?

You are probably referring to the part of the form that says:
If you wish to have us notify your college when you complete this module please complete the following information: Contact email for that College of Registered Nurses in the jurisdiction where you are registered.

You’ll notice that there is no asterisk next to this line in the form – Athabasca does not need this information so you can leave it blank.

What if I successfully complete one of the approved courses and I don’t receive email confirmation from the College that they have received validation from the University?

If three weeks have passed since you successfully completed the course and you have not received email validation from CNO, you can email Customer Service at cno@cnomail.org with the following subject line: Successfully Completed Controlled Substances Course. In the body of the email, please include:

  • the day you successfully completed the course, and
  • whether you completed the Athabasca or University of Ottawa course.

We will look into this and get back to you.

Please do not email before three weeks (it will take three weeks for CNO to receive the information from the university, enter it in our system and then email you confirmation).

Council approved Athabasca University’s course on December 7, 2016, but I successfully completed it before this date. Will you accept previous completion of the course?

Yes. We will accept Athabasca University’s course if it was taken within the last three years.

You do not need to contact us if you already successfully completed Athabasca’s course. Athabasca University will send CNO a validation of successful completion (they have a list of Ontario NPs who successfully completed the course and, as part of their process, they already have your permission to share this information with CNO).

This validation will be sent to CNO regardless of whether you completed the course through Athabasca’s NP program or whether you completed the course for your own professional development.

Once we receive validation of successful completion from Athabasca University, we will notify you by email that you met the requirement. If you do not receive this email validation by the end of January, please see the previous question about contacting the College.

Council approved University of Ottawa’s course on December 7, 2016, but I successfully completed it before this date. Will you accept previous completion of the course? 

We will only accept the University of Ottawa’s course if it was taken on or after January 17, 2014.  

University of Ottawa will email you in December to seek your permission to share this information with CNO (they have a list of Ontario NPs who successfully completed the course). If you wish your information to be shared with CNO, you need to respond to University of Ottawa’s email.

If you have not received University of Ottawa’s email by January 16, 2017, you can email Customer Service at cno@cnomail.org with the following subject line: PREVIOUSLY COMPLETED UNIVERSITY OF OTTAWA COURSE. In the body of the email, please include the date you successfully completed the course. We will connect you with someone who will be able to look into this.

Once we receive validation of successful completion from University of Ottawa, we will notify you by email that you have met the requirement. If you do not receive this email validation, please see the previous question about contacting the College.

Why is University of Ottawa’s course only approved on or after January 17, 2014?

The version of the course approved by Council was launched January 17, 2014.

Why would the College accept courses previously taken?

Council approved that NPs would have met the controlled substances education requirement if they completed the courses in the last three years. This is in the public interest as it is supported by findings in the literature related to knowledge retention.

If I fail the online course, can I take it again?

Yes, you can retake a course. Read the first Q&A for information about registering for one of the approved courses. You must successfully complete one of the approved courses to meet the controlled substances education requirement.

What if I wait to complete the required education after the regulations take effect?

On the day the regulations take effect, your profile on Find a Nurse would state that you are “Entitled to Practise with Restrictions.” Also, at that time, your current employer would be notified of the restriction.

If you complete approved education later on, the restriction will be removed from the register. This takes a few weeks to process.

As part of my NP program in another jurisdiction, the curriculum included controlled substances content. Would this satisfy the requirement or do I need to complete one of the two approved courses?

The only NP program that Council approved as having the controlled substances content integrated into curriculum is Athabasca University. Controlled substances content has been part of Athabasca University’s NP program since May of 2014.

If you completed another program that integrated controlled substances content, you have two choices:

  1. You can complete one of the Council-approved courses – Athabasca or University of Ottawa.
  2. If you completed your program in the last three years, CNO could assess the content from your curriculum to see if it meets the requirements. However, this process takes time and cannot be done in advance of the changes taking effect (this requires collaboration between you, CNO, your school, and then requires Council approval).

If you chose this option, you would be placed on Find a Nurse as “Entitled to Practise with Restrictions” while your course content is being assessed. If the content is validated and the education approved by Council, the restriction on the register would be removed from Find a Nurse. If you want to explore this as an option, please contact the Entry-to-Practice Team at enp@cnomail.org with the following subject line: Need Controlled Substances Curriculum Assessed.

Will CNO cover the cost of the course?

No. CNO will not cover the cost of the course.

I plan to move to another Canadian jurisdiction next year. Will they accept one of the approved courses?

Each jurisdiction sets the requirements for NP practice in their province or territory, so you should contact the nursing regulatory body for that jurisdiction to find out their requirements.

Page last reviewed December 16, 2016