Ontario’s Nurse Practitioners (NPs) will soon see important changes in how they prescribe, manage and handle controlled substances. On Oct. 1, 2026, the federal government’s new Controlled Substances Regulations (CSR) will come into effect, introducing updates that will directly affect Ontario NPs’ practice. All NPs will be required to follow the CSR once it comes into effect.
The CSR, approved in late 2025, will consolidate several existing regulations and bring together six class exemptions into a single, modernized regulation. It will govern activities involving four categories of controlled substances—narcotics, controlled drugs, targeted substances (including benzodiazepines) and restricted drugs—across the health system, including for NPs.
“Whenever government regulations change, CNO has a role to help nurses understand what’s new and what it means for their practice,” said Catriona Mill, Manager, Practice Quality at CNO. “The CSR is the next step in strengthening patient safety and quality care when it comes to the use of controlled substances.”
What this will mean for NPs
Starting Oct. 1, NPs will need to align their practice with several key changes under the CSR:
- New safeguards and documentation requirements: NPs will need to meet enhanced requirements for protective measures, record-keeping and reporting, including new obligations related to post-consumer returns (unused or expired controlled substances returned by patients).
- Expanded authority for returns and destruction: Under specific conditions, NPs will be authorized to destroy post-consumer returns of controlled substances and to sell or provide returned substances to a licensed dealer or the Minister.
- Authority to transport substances: Under specific conditions, the CSR will also authorize NPs to send, deliver and transport controlled substances in accordance with the new regulation.
- Fewer prescribing restrictions: The regulation will remove the previous restriction that prevented NPs from prescribing opium and coca leaves. Since these controlled substances are not marketed drugs, any authorized practitioner who wishes to prescribe them must apply for special access through the Health Canada Special Access Program.
It’s critical for NPs to understand these changes, as they will affect how NPs document, store and manage controlled substances in their day-to-day practice. Ensuring compliance will be an important part of maintaining patient safety.
CNO support and what’s next
CNO is committed to supporting NPs through this transition. In the coming months, we will update FAQs and practice resources on cno.org help you understand what’s changing and how to prepare.
CNO is also conducting a comprehensive review of the Nurse Practitioner practice standard to explore how it may need to evolve to continue supporting patient safety, access to care and quality practice.
Between now and Oct. 1, Ontario NPs should stay informed and review updated guidance as it becomes available. By preparing early, you can continue to provide safe, effective care under the new regulations for controlled substances.