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Dispensing Drugs

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Approved by Council: May 2010
Reviewed and Updated: November 2011, December 2022

 

Policies of the College of Physicians and Surgeons of Ontario (the “College”) set out expectations for the professional conduct of physicians practising in Ontario. Together with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering physician practice or conduct.

Within policies, the terms ‘must’ and ‘advised’ are used to articulate the College’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

Additional information, general advice, and/or best practices can be found in companion resources, such as Advice to the Profession documents.

 

Definitions

Dispensing: refers to the process of preparing and providing a prescription drug to a patient for subsequent administration or use. Dispensing involves both technical and cognitive components.1 For the purposes of this policy, dispensing does not include the distribution of drug samples.2

 

Policy

  1. Physicians who dispense drugs must meet the same dispensing standards as pharmacists3 and comply with the requirements set out in this policy, in any other relevant College policies,4 and provincial and federal legislation.5
  2. Physicians must dispense drugs only for their own patients.
  3. Physicians must:
    1. provide appropriate packaging and labelling for the drugs dispensed;6 and
    2. provide patient counselling, including discussing instructions for proper drug use.
  4. Physicians must not sell drugs to a patient at a profit, except when permitted by legislation.7
  5. Physicians must not charge fees associated with dispensing that are excessive.8
  6. Physicians must not dispense drugs that are past their expiry date or that will expire before the patient completes their normal course of therapy.9
  7. Physicians must:
    1. use proper methods of procurement in order to confirm the origin and chain of custody of drugs being dispensed;
    2. have an audit system in place in order to identify possible drug loss;
    3. store drugs securely;
    4. store drugs appropriately to prevent spoilage (for example, temperature control where necessary);
    5. monitor recalled drugs10 and have a process for contacting patients whose dispensed drugs are affected; and
    6. dispose of drugs that are unfit to be dispensed (for example, expired, damaged, or recalled) safely and securely and in accordance with any environmental requirements.11
  8. Physicians must keep records:
    1. of the purchase and sale of drugs; and
    2. which allow for the retrieval and/or inspection of prescriptions.
 

Endnotes

1. Technical components may include drug selection, verification, and quantity determination, applying appropriate labelling, and documentation. Cognitive components may include assessing the appropriateness of drug therapy, considering drug interactions and contraindications, providing patient communication and counselling, and offering follow-up advice. For more information see the Advice to the Profession.

2. Relevant expectations relating to drug samples can be found in other College policies, including Medical Records Documentation, Prescribing Drugs, and Physicians Relationships’ with Industry: Practice, Education and Research. For more information, see the Advice to the Profession.

3. For example, see the Ontario College of Pharmacists’ (OCP) Standards of Practice.

4. Including, but not limited to, the Prescribing Drugs policy and the Medical Records Documentation policy.

5. Including, but not limited to, the Controlled Drugs and Substances Act, Narcotics Safety and Awareness Act, 2010,  Drug and Pharmacies Regulation Act (DPRA),  Drug Interchangeability and Dispensing Fee Act, and Food and Drugs Act. These acts and their regulations set out requirements for the sale and dispensing of drugs, including labelling, record keeping, and record retention.

6. Subsection 156(3) of the DPRA sets out the information to be recorded on the container of a dispensed drug. The Food and Drug Regulations sets out specific requirements for physicians dispensing Class A opioids. For more information, see the Advice to the Profession.

7. Under O. Reg. 114/94 of the Medicine Act, 1991, it is a conflict of interest to sell or otherwise supply a drug to a patient at a profit except where the drug is necessary for the immediate treatment of the patient, in an emergency, or where the services of a pharmacist are not reasonably readily available (s. 16 (d)).

8. Under O. Reg. 856/93 of the Medicine Act, 1991, it is an act of professional misconduct to charge a fee that is excessive in relation to the services provided (ss. 1(1) 21.), and to charge a fee for a service that exceeds the fee set out in the then current schedule of fees published by the Ontario Medical Association without informing the patient, before the service is performed, of the excess amount that will be charged. (ss. 1(1) 22.) For more information on charging a dispensing fee, see the Advice to the Profession.

9. This requirement does not apply to pro re nata (PRN) medications when physicians may not know whether patients will finish the medication before their expiry date.

10. For instance, through Health Canada’s Recalls and Safety Alerts Database or subscribing to MedEffect Canada notices of recalls.

11. For more information about the safe disposal of drugs, please see the College’s Advice to the Profession: Prescribing Drugs.