Legislative changes impacting Opioid Use Disorder (OUD) treatment

Albertans, Opioids, Physicians, Prescribing | Posted November 2, 2022

Updates to the Mental Health Services Protection Regulation have made changes to treatment for OUD that involve high-potency opioids narcotics. As of October 5, Alberta Health has established the narcotic transition services (NTS).

Who do the changes apply to?

The changes affect physicians with patients being treated for OUD using high-potency opioid narcotics, as well as patients who are treated for OUD with high-potency opioid narcotics. The Mental Health Services Protection Regulation defines high-potency opioid narcotics as “any full-agonist opioid drug with the exception of methadone or slow release oral morphine” (e.g., hydromorphone, diacetylmorphine and fentanyl).

This legislative changes does not include:
- the treatment/prescribing of conventional Opioid Agonist Treatment (OAT) medications such as buprenorphine, methadone or slow-release oral morphine for OUD.
- treatment/prescribing of high-potency opioid narcotics for patients with chronic pain or other medical conditions.

Narcotic transition services

The NTS has been established for people with severe OUD or addiction who have not been able to initiate or stabilize on conventional OAT medications. The NTS is provided in alignment with the Regulation and the Community Protection and Opioid Stewardship Standards.

Alberta Health has provided a fact sheet on the Narcotic Transition Services (NTS). Some key highlights are below:

The NTS aims to stabilize patients on high-potency opioids, then, tapering and transitioning patients to OAT medications.
- Patients will be dispensed their medication for consumption on site, witnessed by a regulated health professional.
The NTS will be available in specified Alberta Health Services (AHS) clinics that have been licensed by Alberta Health.
- All patients who have been receiving high-potency opioids for OUD treatment must be transitioned to one of the AHS clinics by the dates specified below to continue with this form of treatment.
Primary care providers can reach out to AHS for expert support in making these transitions via the AHS Opioid Use Disorder Telephone Consultation services.
- North of Red Deer: call RAAPID North at 1-800-282-9911 or 1-780-735-0811
- South of Red Deer: call RAAPID South at 1-800-661-1700 or 403-944-4488
Certain patients may be permitted to continue with their high-potency opioid narcotics treatment outside of these settings (i.e., hospital, emergency department or designated facility under the Mental Health Act).

Important Dates:

As of October 5, 2022:

NTS is available at the AHS Opioid Dependency Program (ODP) clinics in Calgary and Edmonton.
Existing service providers (defined as a physician or other primary care provider who provided services to a patient using a high-potency opioid narcotics for OUD starting July 1, 2021 to October 4, 2022) begin to transition their existing patients on high-potency opioid narcotics to OAT medications or to AHS clinics.
- Providers who have not provided treatment for OUD with high-potency opioids before, or have not provided treatment since June 30, 2021 are not able to initiate or take on the treatment of individuals with OUD using high-potency opioid narcotics. Providers in this category will be required to refer their patient to NTS.
Support for transitioning patients can be accessed though the Opioid Use Disorder Consultation Service.

As of November 4, 2022:

Existing providers are not permitted to initiate new patients on high-potency opioid narcotics.
Primary care providers continue to transition existing patients on high-potency opioid narcotics to OAT medications or to AHS clinics.

As of February 4, 2023:

In addition to Edmonton and Calgary, AHS clinics are available in Lethbridge, Medicine Hat, Red Deer and Grande Prairie.

As of March 4, 2023:

All patients from primary care providers must be transitioned to OAT medications or to AHS clinics.

CPSA is in the process of updating our Safe Prescribing for Opioid Use Disorders standard of practice. The recent changes do not alter the OAT approval process or CPSA’s OAT program requirements. These changes will align with the Mental Health Services Protection Regulation and the Community Protection and Opioid Stewardship Standards for the NTS. Regulated members are responsible for informing themselves and complying with the legislative requirements that apply to their practice.

Physicians and other primary care providers must ensure that the indication for a high-potency opioid narcotic is clearly listed on the TPP prescription to assist pharmacists in timely and appropriate dispensing. If an indication is not listed, it will not be dispensed. Prescriptions with an indication of OUD can only be prescribed by existing service providers within the timelines and parameters outlined by the NTS.