Pharmacists’ perceptions of the Canadian opioid regulatory exemptions on patient care and opioid stewardship

Abstract

Background: This study explored the perceptions of Canadian pharmacists about the barriers and facilitators of providing opioid stewardship activities in pharmacy practice, considering the subsection 56(1) class exemption under Health Canada’s Controlled Drugs and Substances Act (CDSA). Methods: Qualitative key informant telephone interviews were conducted with a convenience sample of pharmacists from across Canada. We included community or primary health care team-based pharmacists who self-identified as having experience with providing care for patients using opioids via the exemptions. All transcripts were de-identified, and thematic analysis was conducted to identify themes. Ethics approval was obtained. Results: Twenty pharmacists from community and primary health care teams, from all provinces and from urban and rural practices were interviewed. The following themes emerged: 1) optimization of opioid-related patient care, 2) jurisdictional impact and 3) awareness and education. Barriers and facilitators for opioid stewardship activities were identified. Discussion: The exemptions facilitated the pharmacists’ ability to provide opioid stewardship and positively affect patient care by providing continuity of and timely access to care. Our research demonstrated that pharmacists can responsibly and independently manage opioid prescriptions within this expanded scope, demonstrating the valuable contribution pharmacists can have in opioid stewardship. Conclusion: Pharmacists were willing and able to care for patients receiving opioid medication and thereby played a role in helping address the opioid crisis. The benefits of these exemptions were demonstrated beyond situations related to the COVID-19 pandemic and warrant consideration for consistent implementation across provincial and territorial jurisdictions, thereby ensuring equitable access to care for all Canadians.

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

“…Our study explored the expanded role of Canadian pharmacists in providing care to patients with OUD during the COVID-19 pandemic. Given the challenges in access to treatment, the Health Canada exemption enabled pharmacists to independently manage opioid prescriptions and provide continuity of care in a population at higher risk of negative health consequences ( Bishop et al, 2021 , Health Canada, 2020 ).…”

“…All participants provided informed consent prior to the interview. We collected demographic questions and used a semi-structure interview guide with questions that explored their experiences with using the exemption in relation to providing patient care, collaboration with other HCPs, barriers and facilitators for opioid stewardship, and other gaps in providing patient care related to opioid medication ( Bishop et al, 2021 ). The focus of the questions varied based upon the experiences of the pharmacists.…”

“…The purpose of this study was to explore the expanded role of Canadian pharmacists in providing care to patients with OUD during the COVID-19 pandemic. This was part of a larger study that was conducted to better understand the impact of the exemption on the pharmacists’ ability to provide patient care ( Bishop et al, 2021 ).…”

“… Transferring prescriptions Pharmacists may transfer an opioid prescription to another pharmacist. ∧ Provincial variations are described elsewhere ( Bishop et al, 2021 , Canadian Pharmacists Association, 2020 ) …”

“… ∧ Provincial variations are described elsewhere ( Bishop et al, 2021 , Canadian Pharmacists Association, 2020 ) …”