Nurse Practitioner Authority to Prescribe Methadone for Analgesia

On October 20, 2017, Methadone was designated by CRNNL Council as a drug Nurse Practitioners (NPs), who meet specified education and practice requirements, may prescribe for the treatment of analgesia (pain management) as deemed appropriate for a specific client. NPs must complete ALL of the identified education and practice requirements to prescribe Methadone as specified below and receive authorization from the College.

Requirements for NPs to Prescribe Methadone for Analgesia (Pain)

Nurse Practitioners who prescribe Methadone for analgesia must have the individual competence (necessary knowledge, skills, and judgement), including the following:

• Be currently licensed as an NP with authority (without restrictions) to prescribe controlled drugs and substances (CDS).
  • Participate in the Provincial Prescription Monitoring Program.
  • Complete training for the Tamper Resistant Prescription Drug Pad Program and adhere to the ongoing practice requirements of the program.
  • Be registered with the Pharmacy Network via the Newfoundland and Labrador Health Services Digital Health’s HEALTHe NL viewer) and review a patient’s current medication profile before prescribing buprenorphine-naloxone (Suboxone) and/or Methadone.
• Complete specified education and practice requirements to obtain competence in prescribing Methadone:
  • Complete the Centre for Addiction and Mental Health (CAMH) Safe and Effective Use of Opioids for Chronic Non-Cancer Pain Online Course or a course/educational program deemed equivalent by the College.
  • Complete the Methadone for Pain in Palliative Care Course Online at www.methadone4pain.ca or a course/educational program deemed equivalent by the College.
  • Complete the College of Physicians & Surgeons of Newfoundland and Labrador’s (CPSNL’s) Introduction to Safe Prescribing: Opioids, Benzodiazepines, and Stimulants Course available through MDcme.ca at www.mdcme.ca.
  • Attend a minimum of two days of clinical training (or a combination of equivalent hours) with an experienced practitioner/team in the management of pain and the provision of Methadone for analgesia.
  • Be knowledgeable of all CPSNL documents related to pain.
  • Have access to urine drug screening and/or other forms of screening if deemed appropriate for testing of drugs for possible abuse/misuse.
• NPs must ensure they met any additional requirements to prescribe for analgesia e.g., any required education (legislative or manufacturer, etc.).
• If the NP is away from the practice setting for an extended period of time, the NP must reflect on what educational requirements are needed to ensure the NP has the individual competence (necessary knowledge, skills, and judgment) to prescribe Methadone for analgesia.
• NPs may wish to consult with more experienced prescribers of Methadone for pain (e.g., pain management specialists), upon initiating treatment and/or when deemed appropriate.

Application Process Requirements:

Before being granted the authority to Methadone for Analgesia by the College, NPs must:

• Complete the Authority to Prescribe Methadone for Analgesia Application form and submit to the College. NPs can access the Methadone for analgesia application form on the College website.
  • The application form will include a section where:
    • The NP requests to be granted authority to prescribe Methadone for analgesia in their practice setting with rationale for the request.
    • The employer provides written confirmation of employer support and polices for the NP to prescribe Methadone for analgesia in their practice setting. The NP must have policies in place to guide their practice related to prescribing Methadone and care of clients receiving Methadone for pain.
    • The applicable practitioner/team indicates the NP successfully completed two days of training in prescribing Methadone for analgesia/pain management.
• NPs will be required to submit certificate(s) of completion of required courses to the College.
• Once the application is reviewed and deemed to have met all requirements, the NP will be granted authority to prescribe Methadone for analgesia.
  • The NP will receive a letter from the College confirming authority to prescribe Methadone for analgesia.
• A website notification of authorized prescribers will be posted on the College’s public directory, Search for a Nurse.

In addition, NPs who are practising outside of the Provincial Health Authority must follow ALL of the requirements detailed above and:

• Declare that they have access to a mentor who has expertise in the management/treatment of pain and the provision of Methadone for analgesia.
• Declare they have policies to guide their practice in relation to prescribing Methadone for pain and care of the client receiving Methadone for analgesia.