Background
The College recognizes methadone maintenance treatment (MMT) as an effective form of treatment for opioid use disorder and is committed to ensuring that Ontarians receive this treatment in a safe manner. Methadone must be dispensed according to the College’s Opioid Policy, the Centre for Addiction and Mental Health (CAMH) guideline, and the advice provided by the CPSO to safeguard patients receiving this high-risk medication. The CPSO’s MMT “Policy and MMT Program Standards & Clinical Guidelines have been rescinded and the key content has been incorporated into the CPSO Advice to the Profession: Prescribing Drugs (companion resource to the Prescribing Drugs Policy).”
The ideal model for MMT is one that supports the integration of the patient, prescribers, pharmacist, and other members of the health care team to ensure patients have access to treatment and effective transitions of care. This partnership recognizes the unique role each individual plays to ensure desired treatment outcomes are achieved, with the safety of both the patient and the public in mind.
1. Notify OCP
Community pharmacies must inform the College within seven days of starting to dispense MMT and of any changes in this information, using the approved Methadone Dispensing Notification Form.
2. Obtain required references
All pharmacies dispensing MMT must have the most recent edition of the following required references available:
- CAMH Guide: Opioid Agonist Maintenance Treatment: A Pharmacist’s Guide to Methadone and Buprenorphine for Opioid Use Disorder
- CPSO Advice to the Profession: Prescribing Drugs (companion resource to the Prescribing Drugs Policy)
Additional (optional) resources for MMT are provided in the Methadone and Buprenorphine Practice Tool on the OCP website.
3. Adhere to Opioid Policy
Pharmacy professionals are responsible for adhering to the Opioid Policy, including the specific requirements for Opioid Agonist Treatment and the expectations outlined in the CAMH Guide. Pharmacists are also expected to be familiar with CPSO Advice to the Profession: Prescribing Drugs (companion resource to the Prescribing Drugs Policy)
4. Ensure staff are trained
Pharmacists should have the necessary knowledge, skills, and judgment to provide MMT in accordance with the Opioid Policy, prior to engaging in this practice. The Designated Manager (DM) and at least one staff pharmacist of community pharmacies dispensing methadone must complete mandatory education and training.
Mandatory Initial Training
- Designated Manager (DM) must be trained in methadone via the CAMH Opioid Use Disorder Treatment Course or comparable course within six months of beginning a methadone practice.
- In addition to the DM, within one year, at least one staff pharmacist must complete these training requirements
Training update
- Training must be updated at a minimum of every 5 years
- For training updates, pharmacists must complete one of the following Ontario Pharmacist Association (OPA) Addictions Education courses:
- All Pharmacists are encouraged to participate in the OPA Addictions Education program at no cost, through funding from the Ministry of Health and Long-Term Care (MOHLTC).
5. Develop Policy and Procedures
It is recommended that all pharmacies have their own supplementary written policies and procedures to ensure the requirements of the relevant legislation, the College’s Opioid Policy, the Centre for Addiction and Mental Health (CAMH) guideline and the advice provided by the CPSO are consistently met.
In the community setting, the Designated Manager should refer to the CAMH Guide to ascertain where pharmacy-specific operational processes and/or joint policies and procedures with the prescriber may need to be implemented. Important details and standards on topics such as dispensing (e.g. appropriate measuring devices, dilution, take-home doses, labeling, etc.), administration, documentation, and patient agreements can be found within the CAMH Guide.
In the hospital setting, an interdisciplinary approach to the development of policies and procedures is recommended using information from the required references.
6. Responsibility for doses (including Transfer of Custody)
The pharmacist is accountable for the security and integrity of prepared MMT doses until custody is transferred by:
- Dispensing directly to the patient
- Dispensing directly to the physician/delegate*
- Transporting to the physician/delegate* using a method that is secure, auditable, and traceable.
*Physicians may delegate authority for the administration of MMT to other properly qualified healthcare professionals in accordance with CPSO Policy.
The pharmacist must be able to identify who has care and control of the doses at any point in time (i.e. a chain-of-signatures) prior to the transfer of custody. To ensure the security and integrity of the methadone while in transit, pharmacists should consider using tamper-proof boxes or seals, and should avoid extremes in temperature or delays in transport.
