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Q&As: Proposed regulations and by-law changes

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.

The proposed by-law changes will enable the College to post and remove information about prescribing and managing controlled substances on an NP’s profile on the College’s public Register, Find a Nurse. This ensures that the public, employers, other health care providers and stakeholders can find out whether an NP is authorized to prescribe controlled substances.

The information that will be posted on an NP’s profile depends on:

  • if they have met the education requirements as defined in the regulation
  • if there is a Health Canada notice about the NP

The following are answers to questions you may have about the proposed regulation and by-law changes:

PROPOSED REGULATIONS

Why are regulation changes needed?
Currently, federal legislation (Controlled Drugs and Substances Act) gives NPs in Canada the authority to prescribe controlled substances but NPs in Ontario do not have this authority because provincial laws prohibit this authority.   

Are there any prohibitions on what controlled substances NPs can prescribe?
Yes. Under federal legislation, NPs in Canada cannot prescribe heroin, opium, coca leaves and anabolic steroids (other than testosterone).

Given the broad range of health care settings and clients NPs treat, there are no prohibitions proposed at the provincial level. However, Ontario NPs will not be able to prescribe methadone (see Q&A below for more information).

If the regulations are approved can NPs prescribe methadone?
No. Methadone is regulated more vigorously than other controlled substances and requires a Health Canada exemption to prescribe. At this time, there is no process for NPs to obtain this exemption; therefore, NPs will not be able to prescribe methadone.

How will I know when the regulations authorizing NPs to prescribe controlled substances becomes law?
When it becomes law, NPs will receive an email blast and a news item will be posted to cno.org and CNO’s Facebook page. 

PROPOSED BY-LAWS

Related to the proposed by-law changes, it seems punitive to place a restriction on the register. Why is the College proposing this approach?
Prescribing controlled substances is a high-risk activity which will become part of NPs’ scope of practice when the regulations are approved.  Meeting the controlled substances education requirement gives NPs competencies related to safe, effective and ethical prescribing, and managing clients who are treated with controlled substances. It is important that anyone can see if an NP has not met the education requirement and is therefore is not authorized to perform this high-risk activity. 

What are Health Canada notices?
The notice is a letter sent by Health Canada to inform pharmaceutical companies and pharmacies that they must not:

  • sell or provide a controlled substance to a practitioner; and/or,
  • fill a practitioner’s prescription for a controlled substance(s).

A practitioner is any health care provider with these authorities (e.g., physicians and NPs). The notice is also sent to the relevant regulator (e.g., The College of Nurses of Ontario).

There are several triggers for a Health Canada notice including, but not limited to, if the College requests it because the nurse practitioner breached a rule of conduct or is found guilty of a designated drug offence or an offence under the federal regulations.

Page last reviewed December 15, 2016