When prescribing, ordering and administering controlled substances, midwives must meet the General Prescribing and Ordering Standards above and must:
- Have completed a CMBC-recognized certification course on safe prescribing of opioids and benzodiazepines, such as, UBC CPD’s “Opioids and Benzodiazepines: Safe Prescribing for Midwives” course. Graduates of UBC’s Midwifery Education Program after May 2017 are considered certified.
- Ensure a clinical assessment occurs in person within a timely manner prior to prescribing and ordering a controlled substance, except in cases where the client is being assessed in person by another health care provider.
- Adhere to relevant standards, guidelines and policies established by agencies or organizations involved in the provision or control of controlled substances.
- Prescribe the lowest possible dose and the minimum quantity to be dispensed.
- Know, document and inform the client of the risks of co-prescribing opioid and sedative-hypnotic drugs (e.g. benzodiazepines) and limit co-prescribing whenever possible.
- Document their advice to clients about the side effects and risks of controlled drugs and substances as applicable, and implement evidence-informed strategies for minimizing risk.
- Document their advice to clients that they must avoid other central nervous system and respiratory depressants including alcohol, cannabis, and some over-the-counter medications.
- Destroy expired or no-longer-needed controlled substances. This must be witnessed by another midwife, a physician, a registered nurse, nurse practitioner or a pharmacist. Unwanted supplies of these substances may also be surrendered to the pharmacist from whom they were obtained.
- Document their review of the client’s PharmaNet medication profile in the medical record (if PharmaNet is available).
- Document the indication and duration for which the drug is being prescribed, the goals of treatment, and the rationale for the drug’s use over alternatives (if applicable)
- Ensure they do not prescribe refills for controlled substances.
- Appropriately issue prescriptions for controlled substances using regulator-approved controlled drugs and substances duplicate prescription pads, in compliance with the College of Pharmacists of British Columbia BC’s Controlled Prescription Program and Prescription Regulations.
- Ensure that controlled drugs and substances duplicate prescription pads are safely secured when in transit or in use, and stored in a secure and locked area when not in use.
- Store the duplicate copy of each prescription written on controlled drugs and substances duplicate prescription pad within the client health record, not within the controlled prescription pad.
- Report loss, theft or misuse of a controlled drugs and substances duplicate prescription pad to CMBC, PharmaNet Support Services, the police, and, if any client information is contained on the missing pad, the BC Privacy Commissioner.
- Not fax or call in prescriptions requiring use of a controlled drugs and substances duplicate prescription pad.
- Not prescribe controlled substances “for office use.”
- Return controlled drugs and substances duplicate prescription pads to CMBC if no longer practicing in BC or if non-practicing for more than 12 months.
- Consult with appropriate health care professionals if the client’s response to the controlled drug is other than anticipated.
- Follow hospital protocols, record-keeping and security procedures for all prescribing, ordering, administering and disposing of controlled substances
- Advise clients about the dangers of taking controlled substances while performing safety-sensitive occupations, providing child or elder care, and driving.
- Screen for the presence or emergence of mental health disorders (particularly mood disorders) which may complicate management.
*Adapted from the College of Physicians and Surgeons of British Columbia’s Practice Standard: Safe Prescribing of Opioids and Sedatives, the College of Registered Nurses of Nova Scotia’s Nurse Practitioner Standards of Practice and the College of Physicians and Surgeons of Alberta’s Practice Standard: Prescribing Drugs Associated with Substance Use Disorders or Substance-related Harm.
 Regulator-approved controlled drugs and substances duplicate prescription pads are not yet available for use by midwives.