MMT Policy for Pharmacists and Pharmacies Who Dispense Methadone to Patients Requiring Methadone Maintenance Treatment, 2003

NB: This policy has been updated. Please refer to the Policy for Dispensing Methadone, 2006

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Other Methadone documents for Members Only here

• The owner/designated manager of a pharmacy that dispenses methadone shall inform the College of this practice and shall inform the College whether they are accepting new patients and the names of pharmacists who are trained in the dispensing of methadone
• Pharmacies dispensing methadone shall maintain the most recent edition of the publication, Methadone Maintenance: A Pharmacist’s Guide to Treatment (CAMH) as a required reference for the pharmacy library.
• In addition, the following publication produced by the College of Physicians and Surgeons of Ontario (CPSO) is recommended: Methadone Maintenance Guidelines (CPSO, CAMH, OCP, 2001)
• All pharmacies dispensing methadone shall adhere to the principles and guidelines developed in the publication, Methadone Maintenance: A Pharmacist’s Guide to Treatment by Centre for Addiction and Mental Health (CAMH) in the treatment of MMT
• Pharmacies shall use a three-way agreement between the patient, pharmacist and physician (or four-way agreement to include social worker) in dispensing methadone. The agreement will outline the expectations in methadone treatment therapy of all parties
• The agreement will include consent to access personal health information with respect to methadone treatment
• The pharmacy will use a log file (which may include photograph of patient) for signing-off drink and carry doses by the patient and a pharmacy staff witness. At a minimum, positive identification must be shown if the patient is unknown to staff
• Pharmacies will maintain a bulk-compounding log file that contains:
• Date, name (printed) and signature of two staff members (pharmacy technician/pharmacist for double-checking purposes) preparing the stock solution, quantity and lot number of methadone used as well as final quantity made
• Quantity of stock solution used, date, Rx number and name (printed) and signature of two staff members (pharmacy technician/pharmacist) who dispensed/mixed the stock solution with vehicle as prescribed
• Pharmacies must maintain either a Class A prescription torsion balance or an approved electronic scale and maintain a supply of measuring devices suitable for accurately measuring required doses, such as calibrated syringes, measuring pumps, etc
• The label on stock solution bottles must be distinct and easily identified from other bottles. The label on stock bottles shall state the date of manufacture, expiry date, concentration and lot number of methadone used
• Methadone for MMT will be dispensed in a suitable vehicle in unit doses as outlined in the CAMH Guidelines
• Labels on all dispensed unit-dosed bottles of methadone shall be in accordance with the Drug and Pharmacies Regulations Act, section 156. In addition, each unit dose must be uniquely identified with date for ingestion, and the total dose contained in the bottle
• The use of the following auxiliary label: “Methadone may cause serious harm to someone other than the intended patient. Not to be used by anyone other than the patient for whom it was intended.”

• The owner/designated manager shall ensure that all pharmacists are trained in MMT and that all pharmacy staff are trained/knowledgeable in MMT
• All pharmacists dispensing methadone for MMT obtain training via CAMH workshops and/or other College-approved courses and that training be updatedvery five years
• Pharmacists dispensing methadone are recommended to take methadone training as soon as possible to meet these new guidelines, and ensure public safety