Study suggests pharmacists did not overuse their right to prescribe controlled substances during the pandemic

A temporary exemption introduced by Health Canada that expanded pharmacists’ prescribing powers for opioids, benzodiazepines, and stimulants early in the COVID-19 pandemic did not influence Ontario pharmacists to prescribe at higher rates, according to a new study from ICES and Unity Health Toronto.

Though there was a significant increase in pharmacist-prescribed controlled substances two weeks after the exemption was enacted, researchers found the rate of pharmacist prescribing for these medications never exceeded two per cent of the total prescribed claims after the exemption was made. The study was facilitated by researchers at the Ontario Drug Policy Research Network (ODPRN), housed at St. Michael’s Hospital, a site of Unity Health Toronto.

The study comes as Canadians struggle to secure a primary care physician and emphasizes the important role of pharmacists in the community to provide timely care and access to medications, particularly for vulnerable populations.

In response to the COVID-19 pandemic, which resulted in rising opioid-related deaths and a disruption in the continuity of care for patients being treated with controlled substances, Health Canada issued a temporary exemption to subsection 56(1) of the Controlled Drugs and Substances Act (CDSA) in March 2020. The exemption allowed pharmacists to transfer prescriptions to a different Canadian pharmacy, adapt prescriptions by changing a patient's dose or regime of the drug, renew prescriptions, or de-prescribe the drugs altogether.

“These new changes have come with some challenges for pharmacists, including increased demand throughout the pandemic and inadequate staffing at pharmacies,” says Dr. Mina Tadrous, adjunct scientist at ICES and assistant professor at the University of Ottawa. “We wanted to explore how pharmacists adapted to the CDSA exemption, to better understand how to support pharmacists in leveraging this expanded scope of practice.”

The study, published in Canadian Pharmacists Journal, utilized the Ontario Narcotics Monitoring System claims data held at ICES, and compared opioid, benzodiazepine and stimulant prescription claims between the pre-exemption period from January 6, 2019, to March 15, 2020, and the post-exemption period from March 22, 2020, to December 19, 2021. 

The researchers found that:

• There was a significant increase in pharmacist-prescribed opioids (1.5-fold), benzodiazepines (9.6-fold), and stimulants (21.5-fold) two weeks after the exemption was enacted.
• Despite these increases, the absolute rate of pharmacist prescribing was low for these medications, and never exceeded 2 per cent of the total prescribed claims after the exemption was made.
• The total number of opioid prescription claims that exceeded a 30-day supply decreased by 60 per cent, indicating that longer opioid prescriptions were given out less frequently by both pharmacists and other prescribers.

Notably, there was an increase in opioid, benzodiazepine and stimulant claims between December 13, 2020, and January 10, 2021, indicating a potential increase in demand for prescription renewals or adaptations during the holidays, when a patient's primary care clinic would have closed. Further research is needed to better understand patient demographics and outcomes, and when and how specific medications are being used.

“These findings show that pharmacists were sensible in their use of the CDSA exemption,” says Dr. Mina Tadrous. “The other explanation could be that there was lower uptake of the exemption, signaling a need for further training or support so that pharmacists feel confident in leveraging their expanded scope of practice and further supporting a stretched system.”

The study, “Impact of the COVID-19 controlled drugs and substances act exemption on pharmacist prescribing of opioids and benzodiazepines in Ontario: a cross-sectional time-series analysis” was published in Canadian Pharmacists Journal.

Author block: Chang A, Chaudhry S, McCormack D, Gomes T, Shivji A, Tadrous M.

About St. Michael's
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto
Unity Health Toronto, comprised of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.

FOR FURTHER INFORMATION PLEASE CONTACT:

Misty Pratt
Senior Communications Officer, ICES
[email protected]
613-882-7065