Prescribing and Ordering Standards for Controlled Substances

When prescribing, ordering and administering controlled substances, midwives must meet the General Prescribing and Ordering Standards above and must:

  1. 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.
  2. 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.
  3. Adhere to relevant standards, guidelines and policies established by agencies or organizations involved in the provision or control of controlled substances.
  4. Prescribe the lowest possible dose and the minimum quantity to be dispensed.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Document their review of the client’s PharmaNet medication profile in the medical record (if PharmaNet is available).
  10. 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)
  11. Ensure they do not prescribe refills for controlled substances.
  12. Appropriately issue prescriptions for controlled substances using regulator-approved controlled drugs and substances duplicate prescription pads[1], in compliance with the College of Pharmacists of British Columbia BC’s Controlled Prescription Program and Prescription Regulations.
  13. 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.
  14. 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.
  15. 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.
  16. Not fax or call in prescriptions requiring use of a controlled drugs and substances duplicate prescription pad.
  17. Not prescribe controlled substances “for office use.”
  18. 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.
  19. Consult with appropriate health care professionals if the client’s response to the controlled drug is other than anticipated.
  20. Follow hospital protocols, record-keeping and security procedures for all prescribing, ordering, administering and disposing of controlled substances
  21. Advise clients about the dangers of taking controlled substances while performing safety-sensitive occupations, providing child or elder care, and driving.
  22. 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.

[1] Regulator-approved controlled drugs and substances duplicate prescription pads are not yet available for use by midwives.