Prescribing: Drugs Associated With Substance Use Disorders Or Substance-Related Harm*

1. A regulated member must be able to justify prescribing decisions with documentary evidence of a patient’s initial assessment and reassessments as required, including when accepting the transfer of care of a patient from another healthcare provider.
2. At the time of initial assessment, a regulated member must discuss and determine with the patient the best medication choice considering the:
   1. efficacy of other pharmacological and non-pharmacological treatment options;
   2. common and potentially serious side effects of the medication; and
   3. probability the medication will improve the patient’s health and function.
3. A regulated member must review the patient’s medication history from the Pharmaceutical Information Network (PIN)/Netcare or from an alternative, independent source (e.g., Tracked Prescription Program, community or hospital pharmacist):
   1. before initiating a prescription;
   2. before renewing a prescription, unless the regulated member is the primary prescriber; and
   3. at minimum, every three months when the prescription is for the long-term treatment of a patient.
4. Notwithstanding clause (3), if PIN/Netcare is inaccessible and the patient’s medication history is not available from an alternative, independent source, a regulated member may prescribe the minimum amount of medication required until such information can be obtained.
5. A regulated member who prescribes long-term opioid treatment (LTOT) for a patient with chronic pain, exclusive of treatment for active cancer, palliative or end-of-life care, must also:
   1. establish and measure goals for function and pain for the patient;
   2. evaluate and document risk factors for opioid-related harms and incorporate strategies to mitigate the risks;
   3. prescribe the lowest effective dose and, if prescribing a dose that exceeds the opioid prescribing guidelines endorsed by the Council of this College, carefully justify the prescription and document the justification in the patient record;
   4. at minimum, re-assess the patient within four weeks of initiating LTOT and every three months thereafter;
   5. document the status of the patient’s function and pain at each reassessment; and
   6. continue to prescribe LTOT only if there is measurable clinical improvement in function and pain that outweighs the risks of continued opioid therapy.

*Includes, but is not limited to, opioids, benzodiazepines, sedatives and stimulants.