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Advice to the Profession: Prescribing Drugs

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Last Updated: December 2025

 
Advice to the Profession companion documents are intended to provide physicians and physician assistants ("Registrants") with additional information and general advice in order to support their understanding and implementation of the expectations set out in policies. They may also identify some additional best practices regarding specific practice issues.

Opioid agonist treatment

  • Opioid agonist treatment (OAT) is an effective, first-line treatment for opioid use disorder. It is an evidence-based approach that involves using different medications (e.g., methadone, buprenorphine) to prevent withdrawal, reduce overdoses, and decrease cravings for opioids, including fentanyl.
  • As with all prescribing, physicians providing OAT will need to have the knowledge, skills, and judgment to prescribe safely and effectively, taking into consideration the specific needs of their patients. Physicians must prescribe OAT medications for opioid use disorder in accordance with the Prescribing Drugs policy and practise in a manner that is informed by relevant opioid use disorder guidelines, including the Canadian Opioid Use Disorder Guideline, a national clinical guideline developed by the Centre for Addiction and Mental Health.

"Safer supply" prescribing

  • Grounded in the principles of harm reduction, safer supply prescribing involves prescribing pharmaceutical-grade medications (often hydromorphone or other short-acting opioids) to patients with substance use disorder as an alternative to the toxic street supply of illicit drugs. More information on safer supply prescribing can be found on Health Canada's website.
  • As with all prescribing, it is essential that physicians who prescribe safer supply do so in a manner that minimizes the risk of harm and unintended consequences to individual patients (e.g., the potential for misuse or for destabilizing someone previously stable on OAT) and to the broader public (e.g., diversion). As the Centre for Addiction and Mental Health’s Canadian Opioid Use Disorder Guideline states, offering safer supply in conjunction with safety measures can help mitigate these risks.
  • Physicians who are considering prescribing safer supply are reminded that they must follow the expectations of the Prescribing Drugs policy, including that they have the knowledge, skills, and judgment to prescribe safely and effectively. Physicians are further reminded of the importance of careful documentation and, where appropriate, consultation with more experienced providers for guidance and support.

Cannabis authorizations

Accessing patients’ electronic prescription histories

  • As part of their obligation to take reasonable steps to review their patients’ prescription history before prescribing narcotics or controlled substances, physicians can review information available in electronic systems, such as the Digital Health Drug Repository (DHDR).
  • The DHDR is a secure system that provides physicians with electronic access to a patient’s medication and pharmacy records so that they can quickly view a patient’s medication history and provide the best care possible.
  • Information available via the DHDR currently includes:
    • dispensed publicly-funded drugs;
    • publicly-funded pharmacy services (e.g., MedsCheck program; influenza vaccinations); and
    • all dispensed monitored drugs, including narcotics and controlled substances (when the patient used a valid Ontario Health Number).
  • Physicians can access information in the DHDR through either:

Prescription treatment agreements (or “narcotics prescribing contracts”)

  • Prescription treatment agreements, sometimes called narcotics prescribing contracts, are written agreements that outline expectations for both physicians and patients when drugs with a potential for abuse, misuse, or diversion (e.g., opioids) are prescribed.
  • Prescription treatment agreements are not required by the College nor are they recommended by the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain; however, physicians may use them as an educational (rather than punitive) tool, in support of safe and effective prescribing and in keeping with their own professional judgment.

Reporting adverse drug reactions or medication incidents

  • Physicians support the ongoing evaluation of prescription drug safety by reporting actual and suspected adverse drug reactions and medication incidents to the appropriate organizations (outlined below). Reporting helps identify safety concerns early and prevent harm. Physicians are encouraged to report drug interactions that are unexpected, serious, or related to recently marketed health products.
  • Physicians can report adverse drug reactions to Health Canada’s Vigilance Program at http://www.hc-sc.gc.ca/dhp-mps/medeff/vigilance-eng.php and medication incidents through the Institute for Safe Medication Practices Canada at https://www.ismp-canada.org/err_report.htm.
  • Physicians can also encourage their patients to report any medication incidents at http://www.safemedicationuse.ca.

Endnotes

  1. For example, the Canadian Research Initiative in Substance Misuse National Guidelines for the Clinical Management of Opioid Use Disorder,  Health Quality Ontario’s Opioid Use Disorder Quality Standard, and META:PHI’s guidelines on Methadone as Opioid Agonist Therapy and Recommendations for Use of Slow-Release Oral Morphine as Opioid Agonist Therapy.

  2. “Harm reduction” refers to evidence-based, patient-centred approaches to care that seek to reduce the health and social harms associated with addiction and substance use but that do not necessarily require people who use substances to abstain from them.

  3. Clinical connect is a secure, web-based portal that gives health care providers real-time access to the patients’ electronic medical information from all acute care hospitals, Local Health Integration Networks’ (LHIN) Home and Community Care Services, and Regional Cancer Programs in South West Ontario, in addition to various provincial clinical data repositories.

  4. The Connecting Ontario Clinical Viewer is a secure, web-based portal that provides real-time access to digital health records including dispensed medications, laboratory results, hospital visits, Local Health Integration Networks’ (LHIN) Home and Community Care Services, mental health care information, and diagnostic imaging reports and images.

  5. In addition to reporting any adverse drug reactions or medication incidents, physicians can find additional requirements for reporting (as applicable) in the College’s Disclosure of Harm policy.

  6. Adverse drug reactions are unwanted effects that happen when drugs are used under normal conditions. Adverse drug reactions are also called side effects. Adverse drug reactions are not medication incidents. Unlike a medication incident, an adverse drug reaction generally doesn’t involve a mistake and typically can’t be prevented.

  7. A medication incident is a mistake with medication, or a problem that could cause a mistake with medication. "Medication error" is another name for one kind of medication incident. Medication incidents include obvious things like receiving the wrong medication or dose, but might also include problems like a confusing label that might lead to someone receiving the wrong medication.

  8. Health Canada’s Adverse Reaction Information webpage describes a serious adverse drug reaction as one that requires in-patient hospitalization or prolongation of existing hospitalization, causes congenital malformation, results in persistent or significant disability or incapacity, is life-threatening or results in death. Adverse reactions that require significant medical intervention to prevent one of these listed outcomes are also considered to be serious.