In an effort to combat the abuse, misuse, and diversion of prescription fentanyl, the provincial government has passed new which requires patients who receive a prescription for fentanyl to return their used patches to a pharmacy before receiving new ones. The College of Physicians and Surgeons of Ontario (CPSO) and Ontario College of Pharmacists (OCP) strongly support this new legislation, as well as the government’s approach to delineate specific roles and responsibilities for physicians and pharmacists when prescribing and dispensing fentanyl. Requirements of the legislation: When prescribing fentanyl patches: • Prescribers must record on every prescription for fentanyl the name and address of the pharmacy where the prescription will be filled. • Prescribers must notify the pharmacy in advance that each prescription has been written, either by faxing a copy of the prescription to the pharmacy or by telephone.

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• When writing a patient’s first prescription for fentanyl, prescribers must note “first prescription” on the prescription itself. A prescription is considered a “first prescription” when: i. The prescriber has not previously prescribed a fentanyl patch for that patient; and ii. The prescriber is reasonably satisfied that the patient has not previously obtained a prescription for fentanyl from another prescriber. When dispensing fentanyl patches: • Dispensers must confirm that the name and location of the pharmacy is recorded on the prescription by the prescriber, and the pharmacy has been notified by the prescriber of the prescription before any patches are dispensed. • Unless a first time prescription, dispensers must only dispense fentanyl in exchange for used patches provided by the patient or his or her authorized representative.

• Dispensers must examine and document returned patches, and store them in a secure location prior to proper destruction as outlined in the College’s Fact sheet –. • Where a dispenser receives a prescription for fentanyl patches but does not collect all of the patient’s used patches, or collects fewer patches than the quantity to be dispensed under the prescription, he or she must: i. Dvr Net Viewer Free Download here.

Use his or her professional judgment to dispense an appropriate number of patches based on an assessment of the patient, including an assessment of the patient’s circumstances and the patient’s medical condition; and ii. Notify the prescribing physician of the number of used patches that were collected as well as the number of new patches that were dispensed, if any. • Dispensers apply exceptions in the following circumstances: i. A prescription has been authorized by a prescriber from outside Ontario, and the prescription is verified by the dispenser; or ii.

Another pharmacy is listed on the prescription, and the authenticity of the prescription is verified by the dispenser, and no fentanyl patches were dispensed by the other pharmacy. • Dispensers apply exceptions when dispensing to a resident of a long-term care home, a person who is confined in a correctional facility, or a patient of a hospital, in the following circumstances: i. The facility has a written policy establishing a medication management system for the collection and administration of fentanyl patches; and ii. The dispenser has a copy of the policy. Supplementary guidance for physicians: Where applicable, the above requirements regarding fentanyl patches have been incorporated into the CPSO’s policy.