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Prescribing Drugs: Limits and Conditions


Limits and Conditions

The table below sets out the limits and conditions for nurse practitioner prescribing. These limits and conditions supplement the prescribing standards listed above. Nurse practitioners who are uncertain about their authority to prescribe a certain drug should contact BCCNP regulatory practice support at practice@bccnp.ca.

1.

Nurse practitioners do not prescribe controlled drugs and substances or authorize medical cannabis14 for themselves, a family member, or anyone else who is not a client the nurse practitioner is treating in their professional capacity.

2.

Nurse practitioners do not prescribe non-controlled drugs and substances for themselves or a family member except for a minor/episodic condition and only when there is no other prescriber available.

3.

Nurse practitioners do not provide any person with a blank, signed prescription.

4.

Nurse practitioners do not provide any person with a blank, signed medical document for cannabis.

5.

Antiretroviral therapy for the prophylaxis or treatment of HIV infection

a.

Nurse practitioners who prescribe antiretroviral therapy for the prophylaxis or treatment of HIV infection must meet the education requirements of the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE).

b.

Nurse practitioners apply the clinical practice guidelines of the BC-CfE when prescribing antiretroviral therapy for the prophylaxis or treatment of HIV infection.

6.

Blood and blood products

a.

Nurse practitioners who prescribe blood and blood products must meet the standards, limits and conditions set out in E. Advanced Procedures and Activities.

7.

Cosmetic treatments

a.

See the limits for cosmetic treatments (e.g. Botox Cosmetic®) set out in E. Advanced Procedures and Activities.

8.

Cancer drug treatment15

a.

Nurse practitioners who prescribe cancer drug treatment must meet the education requirements of BC Cancer.

b.

Nurse practitioners apply the clinical practice guidelines of BC Cancer when prescribing cancer drug treatment.

9.

General anesthetics

a.

Nurse practitioners do not prescribe general anesthetics for the purpose of inducing general anesthesia.

b.

Nurse practitioners who prescribe general anesthetics for the purpose of medical assistance in dying must meet the standards, limits and conditions set out in H. Medical Assistance in Dying.

10.

Controlled drugs and substances

a.

Before prescribing controlled drugs and substances, nurse practitioners must register for PharmaNet access appropriate to the practice sites where they will be prescribing controlled drugs and substances (e.g. Community Health Practice Access to PharmaNet).

b.

Nurse practitioners who prescribe controlled drugs and substances must successfully complete one of the following courses:

 

i.

University of Ottawa: Prescribing Narcotics and Controlled Substances

 

ii.

Athabasca University: Prescription and Management of Controlled Drugs and Substances

 

iii.

Saskatchewan Polytechnic: Controlled Drugs and Substances Act (CDSA) Module for Nurse Practitioners

 

iv.

University of Toronto: Controlled Drugs and Substances Essential Management and Prescribing Practices

c.

Nurse practitioners who prescribe controlled drugs and substances must complete BCCNP’s Controlled Drugs and Substances (CDS) Prescribing Module.

d.

Nurse practitioners who prescribe controlled drugs and substances must meet the BCCNP Competencies for NP Prescribing of Controlled Drugs and Substances for the context or contexts in which they are prescribing.

NOTE: See also prescribing limits 1, 2, 3 and 4 above.

The following limits and conditions  for prescribing CDS are in addition to 10 a-d above

10.1

Chronic Non-Cancer Pain16

In addition to 10a–d, nurse practitioners who prescribe controlled drugs and substances for chronic non-cancer pain must complete additional education.17

10.2

Methadone for analgesia

In addition to 10a–d, nurse practitioners who prescribe methadone for analgesia must complete:

i.

the Methadone for Pain in Palliative Care course offered by the Canadian Virtual Hospice

ii.

a preceptorship with an experienced methadone for analgesia prescriber

10.3

Opioid agonist treatment for opioid use disorder

In addition to 10a–d, nurse practitioners who prescribe opioid agonist treatment for opioid use disorder must meet the standards, limits and conditions set out in G. Opioid Agonist Treatment Prescribing for Opioid Use Disorder.

10.4

Medical Assistance in Dying

In addition to 10a–d, nurse practitioners who prescribe drugs for the purpose of medical assistance in dying must meet the standards, limits and conditions set out in H. Medical Assistance in Dying.

10.5

Amphetamine, Benzphetamine, Methamphetamine, Phendimetrazine, Phenmetrazine, and their salts

Nurse practitioners prescribe these controlled drugs and substances only for the treatment of narcolepsy, hyperkinetic disorders in children, epilepsy, parkinsonism, or hypotensive states associated with anesthesia as per the federal Food and Drug Regulations Section G.04.001.

Note: Nurse practitioners have full prescribing authority for dextroamphetamine as it is not considered a designated drug under the Food and Drug Regulations Section G.04.001.

Please refer to the following announcement for additional clarification: www.bccnp.ca/bccnp/Announcements/Pages/
Announcement.aspx?AnnouncementID=41

10.6

Anabolic steroids and their derivatives

Nurse practitioners do not prescribe anabolic steroids or their derivatives, except    testosterone, as per the federal New Classes of Practitioner Regulations Section 4(2)(a).

Nurse practitioners prescribing testosterone also meet 10a–d, as above.

10.7

Coca leaves

Nurse practitioners do not prescribe coca leaves as per the federal New Classes of Practitioner Regulations Section 4(2)(b).

10.8

Opium

Nurse practitioners do not prescribe opium as per the federal New Classes of Practitioner Regulations Section 4(2)(b).

Footnotes

14.

As noted in footnote 7, "medical cannabis" does not include Schedule 1 drugs containing cannabis.

15.

Cancer drug treatment: treatment using drugs which inhibit or prevent the proliferation of cancers, including chemotherapy, hormonal therapy, immunotherapy, targeted therapy and others (BC Cancer).

16.

Chronic non-cancer pain is pain with a duration of three months or longer that is not associated with a diagnosis of cancer (National Pain Centre, 2017).

17.

Additional education is structured education (e.g. workshop, course, program of study) designed so that nurse practitioners can attain the competencies required to carry out a specific activity as part of nurse practitioner practice. Additional education builds on the entry-level competencies of nurse practitioners, identifies the competencies expected of learners on completion of the education, includes both theory and application to practice, and includes an objective, external evaluation of learners’ competencies on completion of the education. The term does not refer to a course or program approved by BCCNP for BCCNP certified practice.

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