The BC Cancer Pain & Symptom Management / Palliative Care clinics transfer patients back to community physicians once symptoms have been stabilized and other palliative care needs have been addressed, so that care can be provided closer to home and for clinics to maintain capacity for new patients. Some transferred patients include those who require long-term opioid therapy, including methadone for analgesia.
Health Canada announced that effective May 19, 2018, prescribers will no longer require a federal exemption to prescribe methadone. This announcement results after an extensive national consultation on subsection 56(1) of the Controlled Drugs and Substances Act.
As set out in the College of Physicians and Surgeons Bylaws, physicians are required to practise medicine within their scope of practice and should, therefore, acquire the relevant knowledge, training and experience before initiating patients on methadone.
Registrants who do not currently have a section 56(1) exemption, or have not prescribed in more than three years must obtain relevant education and training by completing the Methadone for Pain in Palliative Care Course, and read the College's Methadone for Analgesia Guidelines. The course takes about 1 hour, is free, and is fully CME-accredited by both Colleges.
Please visit the College of Physicians and Surgeons
website for more information on the requirements.
As set out in the College of Registered Nurses of BC*, Nurse Practitioners (NPs) are also able to prescribe Methadone as analgesia. In order to do so they must first have completed the CRNBC requirements for Controlled Drugs and Substances training.
NPs who prescribe methadone for analgesia must complete the
Methadone for Pain in Palliative Care Course offered by the Canadian Virtual Hospice and a preceptorship in keeping with their specific learning needs. It is expected that NPs prescribing Methadone for analgesia will largely be working within BC Cancer and in that case, preceptorship arrangements will be made internally in conjunction with the BC Cancer policies.
Some cancer patients may benefit from palliative procedures such as nerve blocks, cryoablation, cementoplasty, epidural steroid injections etc., and it can sometimes be difficult to select the most appropriate procedure. A multidisciplinary case conference is held on the 1st and 3rd Tuesday of every month where these complex situations can be discussed. The referring physician is expected to attend in person or by teleconference, and communicate the consensus of the conference to the patient and any other relevant individuals. They are also responsible for making the appropriate arrangements for any recommended procedure after the conference. The
referral form for the case conference can be found
here.
