(89) 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

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1134

Presenting Author(s)

Mina Tadrous, PharmD, PhD, MS
– Assistant Professor, University of Toronto, Toronto, Ontario, Canada

Co-Author(s)

Ann Chang
– University of Toronto, ON, Canada
Shanzeh Chaudhry
– University of Toronto, Canada
Daniel McCormack
– ICES, Canada
Tara Gomes
– Scientist, Toronto, Ontario, Canada
Anisa Shivji
– Ontario College of Pharmacists, Canada

Background: Due to the 2019 coronavirus (COVID-19) pandemic, there were major concerns of disruptions to patient care. One major healthcare system concern was maintaining continuity of care in patients receiving any chronic treatment. Disruptions to primary care during the pandemic could put individuals at risk of withdrawal symptoms or serious adverse outcomes, particularly those chronically treated with controlled substances. Health Canada issued an exemption to the Controlled Drugs and Substances Act (CDSA) on March 19, 2020, enabling pharmacists to act as prescribers of controlled substances to support continuity of care that would be broken due to the pandemic.

Objectives: Our study investigates utilization of the CDSA exemption by Ontario pharmacists to inform policy on pharmacist scope of practice with the aim to improve patient health outcomes.

Methods: We conducted a time-series analysis of pharmacist-prescribed opioid and benzodiazepine claims data using Ontario Narcotics Monitoring System (NMS) data between January 2019 to March 2021. We used ARIMA modelling to measure the change to number of both classes of claims and to the proportion of pharmacist-prescribed claims.

Results: Post-exemption, the average weekly number of pharmacist-prescribed opioid and benzodiazepine claims rose by 212% (161 to 341 claims/week) and 956% (48 to 462 claims/week), respectively. There was a 2-week lag period between the time of announcement and the statistically significant increase in claims on April 5, 2020 (p < 0.0001). Pharmacist-prescribed claims for opioid quantities exceeding a 30-day supply decreased by 225%. Cumulative pharmacist-prescribed claims accounted for under 1% of the total NMS claims.

Conclusions: Ontario pharmacists utilized the CDSA exemption but were prescribing at low rates. These findings suggest an effective change to pharmacy practice that may lead to future changes to pharmacist scope to benefit patients and alleviate pressure on the healthcare system.