On May 19, 2018, Health Canada removed the requirement for an exemption under section 56(1) of the Controlled Drugs and Substances Act to prescribe methadone. Subsequently, the College of Physicians and Surgeons of British Columbia has released appropriate guidance on prescribing methadone, a Methadone for Analgesia Guidelines, and a new Prescribing Methadone practice standard.
Physicians are expected to acquire the relevant education and training to prescribe methadone for analgesia and/or opioid use disorder as outlined in the standard, be familiar with the Safe Prescribing of Opioids and Sedatives practice standard, and commit to regularly reviewing each patient’s PharmaNet profile.
Methadone for Analgesia
Physicians with limited experience with the use of methadone for analgesia are strongly encouraged to consult with an experienced colleague before starting a patient on methadone. It is not recommended to initiate methadone in patients who are considered opioid-naïve (no prior exposure to, or intermittent use of, opioids), except in certain palliative or end-of-life care situations.
To prescribe methadone for analgesia, physicians must use the regular duplicate prescription pad. To prescribe methadone for opioid use disorder, physicians must use the methadone controlled prescription pad. Please ensure timely ordering of prescription pads in order to maintain continuity of care for patients.
Consult the Controlled Prescription Program for information on how to order duplicate or methadone prescription pads. Physicians should contact the College to confirm the address for courier delivery.
Methadone for Opioid Use Disorder
Physicians seeking education and guidelines regarding the use of methadone or other treatments for opioid use disorder should contact the BC Centre on Substance Use.
Please refer to the Patient Information section for more information.
- Methadone for Pain in Palliative Care
- Prescribing Methadone practice standard
- Methadone for Analgesia Guidelines
- Medications metabolized by cytochrome P450 3A4
- Drugs associated with QT interval prolongation
Note: Any third party links are provided for general reference only and no endorsement of their content by the College is implied.
Overdose Prevention and Response Training
Toward the Heart is a provincial harm reduction initiative designed to equip members of the public to respond in case of an opioid overdose.
Physicians should consider providing patients who may be at risk of overdose with naloxone. The BC Centre for Disease Control has a Take Home Naloxone Program, which provides information to health-care workers and the public.
For more information about the program or to find the nearest training site, visit the Toward the Heart website.
Naloxone available in BC without a prescription
Naloxone is available outside of pharmacies without a prescription and for free at community pharmacies. It is important that anyone administering naloxone call 9-1-1 first, and be aware that naloxone may cause withdrawal symptoms for the patient. Family and friends should be adequately instructed on how to recognize the signs of overdose, how to administer naloxone, and how to monitor the patient’s progress until help arrives.
For more information and resources regarding naloxone, visit the College of Pharmacists of BC website.