Naureen Aqueel

New prescribing powers do not apply to Ontario nurses

Posted on: November 27, 2012

Published in The Ward, Nov 27, 2012. 

New federal regulations that aim to give more health-care providers the authority to prescribe narcotics and other controlled substances will not immediately take effect in Ontario because of a provincial law that prohibits this practice.

The federal government announced new regulations last week that allow nurse practitioners, podiatrists and midwives to prescribe certain medications classified as controlled substances, including morphine, codeine, fentanyl and diazepam.

The move is aimed at improving health care service delivery, said Jocelyn Kula, manager of the regulatory policy division for Health Canada’s Office of Controlled Substances.

Health Canada published the regulation covering a “new classes of practitioners” on Nov. 21.

“What they broadly do is to remove any federal impediments to certain classes of health professionals being able to prescribe controlled substances,” Kula said. “But the catch is that in order for one of the classes of health professionals to be able to use their new authority, they need to have the similar authority provided to them at the provincial or territorial level.”

Kula said the new regulations should allow patients to get care and access to drugs in a more timely manner. People will no longer have to go to multiple health-care professionals or jump through various hoops before getting required care or drugs.

Midwives in provinces that allow them to prescribe the listed drugs will also be allowed to provide access to medication for women who choose to have a home birth. They wouldn’t have to wind up in hospital just to access drugs needed to ease labour, Kula said.

Kula said the new regulations came into effect after a series of requests and exchanges from certain provinces and professional health associations, which informed Health Canada that the limits in prescribing authority were disrupting the delivery of health services.

The College of Nurses of Ontario issued a notice to nurse practitioners in the province after Health Canada published the new regulations, alerting the health-care providers that it was still illegal for them to prescribe any controlled substances, including narcotics, under the provincial Nursing Act.

Bill Clarke, a college spokesman, said in an email that all the federal changes have done is to give each province the power to make its own decisions around the prescribing authority of practitioners.

“Now, however, with this change in federal law, the College of Nurses of Ontario has the power to propose changes to the Ontario Ministry of Health around nurse practitioners prescribing of these drugs,” Clarke said.

“The college will work with Ontario’s nurses and stakeholders to develop provincial regulations around this aspect of nurse practitioners’ practice in a manner that supports the public interest and builds confidence in nursing regulation.”

No one was available for comment from the provincial health ministry.

The Canadian Nurses Association called the new regulations a “milestone for nurse practitioners and the patients they care for.”

Nurse practitioners – who are experienced registered nurses with advanced training and education that allows them to make certain medical diagnoses, write some prescriptions and administer some treatments – have often been called vital links that help make the health-care system more efficient.

Although a majority of them work in community health centres and family health teams, they can also be found in emergency departments and long-term care institutions. In the past, moves to expand the powers of nurse practitioners have been hailed as key to preventing overcrowding and speeding the delivery of care.

Last month, British Columbia approved regulation to allow nurse practitioners to admit and discharge patients, becoming the second jurisdiction in Canada, along with Ontario, to allow those powers.

While many in the medical community have welcomed the new regulations, not everyone is excited about this decision. Joanna Binch, a nurse practitioner at the Somerset West Community Health Centre in Ottawa, said that while she has been in situations where she could have prescribed something to a patient, she was happy to have not had the authority to do so, particularly when prescribing narcotics.

“The situation that I run into much more often is that people are requesting narcotics,” Binch said.

“And I often like not being able to prescribe them because I can say, ‘Look, I know you have an addiction or you would like this, but this is not something I can deal with. Let me talk about anything else you would want to talk about.’ And it just changes the priority of the visit. But as I say, I’m sure this is not the case for many nurse practitioners who are in different settings.”

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