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Currently, NPs in Ontario do not have the authority to prescribe controlled substances.
On December 7, 2016, Council approved draft regulations and by-laws to be sent to nurses and stakeholders for feedback. If approved by Council and government in the future, the regulation changes will expand NPs’ scope of practice to include prescribing controlled substances.
What are controlled substances?
A controlled substance is a medication that is restricted by federal law (under the Controlled Drugs and Substances Act). These medications are restricted because they present a high risk of abuse, addiction and diversion. Controlled substances are used in healthcare to treat a wide variety of conditions including, but not limited to, pain, anxiety and sleep disorders. They include narcotics (e.g., morphine), benzodiazepines (e.g., diazepam) and controlled drugs (e.g., testosterone). NPs need to be able to prescribe these medications to independently meet client needs.
What evidence supported the proposed changes to NP scope of practice?
A significant amount of policy work was done to inform decision-making, including:
- an analysis of relevant legislation
- literature reviews
- a review of other regulators’ policies
A national working group under the Canadian Council of Registered Nurse Regulators was launched in 2012 to establish a national approach to regulating this new area of practice. Joint work included a literature review, identifying education competencies and courses, as well as next steps to be taken within each jurisdiction (for example, integrating into program approval).
In 2013, the College conducted a survey of Ontario NPs to better understand practice realities associated with the use of controlled substances (for example, relevance of specific controlled substances to their practice setting/client population, learning needs, existing supports, and attitudes and concerns about the risks associated with controlled substances). In addition, in 2014, the College consulted on proposed core competency indicators and practice expectations with several key stakeholders.
Isn’t prescribing controlled substances a risky activity? Why give NPs this authority now?
Yes. Activities associated with controlled substances are high risk (e.g., potential for misuse, addiction, diversion). Yet these risks need to be balanced with ensuring clients have access to appropriate treatment. Ontario NPs frequently assess clients with conditions that may require controlled substances for treatment. If NPs can’t prescribe controlled substances, clients may not get the treatment they need or their treatment may be delayed.
Safe, effective and ethical prescribing includes practitioners being able to assess and identify potential and actual medication misuse, addiction and diversion. Education and other regulatory mechanism will address the risks associated with controlled substances so NPs can prescribe safely, effectively and ethically.