Prescribing/Supplying Opioids, Benzodiazepines/Z-Drugs to Travellers or “Snowbirds”
Updated August 31, 2022
CPSM Standards for Prescribing Opioids and Benzodiazepines and Z-Drugs came into effect on September 30, 2018, and November 1, 2020, respectively. The College of Registered Nurses of Manitoba (CRNM) Practice Direction for RN(NP) Opioid Prescribing to Treat Non-Cancer Pain has been in effect since March 2020. On April 15, 2021, the College of Pharmacists of Manitoba (CPhM) Companion Document to the CPSM Standards of Practice was also approved.
Prescribing and Dispensing of Opioids and Benzodiazepines
On an exceptional basis, prescribers may only authorize a dispensing interval of up to three months for these medications for patients in remote communities or for travel, if the patient has been on a stable long-term prescription. The exception should be noted on the prescription. This limit also applies to those patients who may leave the country for longer than three months at a time, including “snowbirds”.
Although patients may be approved by Manitoba Health and Seniors Care to receive six months’ of medication for out-of-country travel, prescribing or supplying more than three months of opioids, benzodiazepines, and/or Z-drugs is not acceptable.
Travellers or “snowbirds” who will be away for longer than three months, and who will need a refill while away, are to see a practitioner in the country where they are travelling for proper assessment to receive a valid prescription. Seeing a provider is part of the cost of such extended international travel, including the health insurance needed for such travel.
Virtual Medicine Across Borders
The legal interpretation of the Regulated Health Professions Act, Regulations, and common law concludes that the location of medical care in Manitoba is the location of the patient. The CPSM Standard of Practice for Virtual Medicine, effective November 1, 2021, reinforces this. The onus is on the care provider to determine the patient's location if providing care virtually. The CRNM also has resources for Telepractice and Guidance on Telepractice, developed with other Manitoba regulatory colleges.
A Manitoba prescriber cannot provide care to a Manitoba patient in another country by virtual care/phone call to renew or adjust a prescription while the patient is travelling. CPSM registration does not extend to the provision of medical care in that country. Likewise, medical liability insurance may not cover a Manitoba physician or RN(Nurse Practitioner) who provides care to a patient while in another country. Similarly, CPSM registration does not extend to the provision of medical care in another province. Medical care is defined as any health care that a CPSM registrant provides in the course of their practice - this includes providing prescription refills. Manitoba-licensed physicians wanting to provide care in another province will need to be aware of and comply with licensing and liability requirements in that Canadian jurisdiction. RN(NP)s are expected to contact the regulatory body in the province/territory where the client lives to determine if they need to be registered in that jurisdiction before providing healthcare services to the client in that location.
It is important for providers to make their patients aware of this before they travel. The Info Sheet on Virtual Medicine Across Provincial & International Borders may be a helpful resource for physicians and pharmacists providing care to travelling patients. Note that shipping narcotics, controlled drugs and substances, and/or targeted substances from Canada to other countries is not advised and may not be legal.
Creating Standards of Practice
A large interprofessional working group of experts diligently reviewed all available evidence and data related to prescribing and dispensing practices of these medications to create the CPSM Standards. A robust public and professional consultation phase followed this work and feedback was incorporated into the Standards. The CPSM Standards, CRNM Practice Direction, and associated CPhM Companion Document all balance the risks and benefits of various difficult decisions, in the interest of patient and public safety.