Standards for Control and Prevention of Diversion or Abuse of Controlled Substances in Midwifery Practice

Revised: June 13, 2017

General Prescribing Practice

Midwives are required to follow hospital protocols, record-keeping and security procedures for all prescribing, ordering, administering or disposing of controlled substances.

Writing Prescriptions: Prescriptions must be written on duplicate regulator-approved prescription pads in a manner so that they are difficult to alter. Please note that while CMBC is working on this, RMs do not currently have access to duplicate prescription pads. Prescription pads should be stored out of sight in a secure location in the office and never left unattended in a medical bag. No refills are allowed.

Unique Identifier Number: Midwives must use a unique identifier number when prescribing controlled substances.

Destroying Out-of-Date Drugs & Substances: Out-of-date controlled drugs and substances, or those no longer needed, must be destroyed by the midwife. This act must be witnessed by another midwife, a physician, a registered nurse, nurse practitioner or a pharmacist. Unwanted supplies of these drugs may also be surrendered to the pharmacist from whom they were obtained.

Adverse Drug Reaction: Midwives must participate in the Canadian Adverse Drug Reaction Reporting Program which includes reporting adverse reactions to vaccines.

Protection: Midwives must take reasonable steps to protect controlled substance from loss or theft. Any losses or thefts must be reported to Health Canada’s Office of Controlled Substance, to the CMBC, to the hospital as indicated and to a law enforcement agency.

Evidence-Informed Prescribing: Midwives must consider best-practice resources and guidelines when prescribing for clients, including when recommending complementary or alternative therapies.

Ethics: It is unethical and prohibited for a midwife to self-prescribe or administer a controlled substance or to prescribe a controlled substance to immediate family.

Demonstrating Competence: Currently practicing midwives will demonstrate their knowledge and competence to the CMBC through an approved education and assessment process prior to being authorized to independently prescribe, order and administer these controlled substances. Once prescribing, ordering and administering controlled substances is fully implemented as an entry-level competency, applicants for registration will have their knowledge and competence to independently prescribe, order and administer designated controlled substances assessed through their education program.

Prescribing Principles for Pain Relief

CMBC prescribing principles are intended to be used as a guide for midwives to ensure safe prescribing practices to all their clients.

  1. Opioids prescribed by midwives are intended to be prescribed to their clients on a short-term basis and within a specific time period;
  2. Treatment decisions are based on comprehensive initial and ongoing assessments and informed choice. Each assessment should include a documented history, examination, assessment and summary of the opioid treatment;
  3. Always prescribe the lowest effective dosage. Medications must be tapered or discontinued if problems arise;
  4. Both long and short acting opioids have the potential for abuse. Be cautious of alcohol use and/or polypharmaceutical mix of drugs, which can include opioids, sedatives, antidepressants and atypical antipsychotics. There is no evidence or assurance that this is safe or effective, and these combinations increase the risk of adverse effects;
  5. Do not prescribe opioids with sedatives, particularly benzodiazepines. Use of this combination increases the risk of fatal opioid overdose;
  6. Any controlled substances requiring a duplicate prescription pad may only be prescribed in hospital, as midwives do not currently have access to duplicate prescription pads. Please note that midwives can only prescribe controlled substances based on the medications listed in the CMBC Standards, Limits and Conditions for Prescribing Controlled Substances.
  7. Prescriptions can only be written for a client’s individual needs and may not be prescribed “for office use”.

Note: A review of PharmaNet at the time an opioid is prescribed in order to access an updated client profile is considered best practice. At this time Registered Midwives do not have access to PharmaNet.