Clarifications for commonly asked questions and feedback obtained during the consultation regarding the MAiD Restocking Policy.
There is currently a shortage of drugs used in the Medical Assistance in Dying (MAiD) protocol due to the COVID-19 pandemic increasing demand for these drugs to treat patients on ventilators in hospital intensive care units, as well as an overall increase in demand for MAiD. Once the emergency order has been lifted in Ontario, this policy will be rescinded, and the College will continue to monitor the status of the drug shortages and determine whether development of a permanent restocking policy is warranted.
Given this is a situation where expeditious advice is needed, and this policy is only intended to be in effect for the duration of the COVID-19 public health emergency in Ontario, the College presented this policy to the Board for temporary application during the COVID-19 public health emergency, and truncated the typical policy development process. Once the emergency order has been lifted in Ontario, the College will continue to monitor the status of the drug shortages and determine whether development of a permanent restocking policy is warranted. A permanent policy would follow the typical policy development process including a public consultation.
Only accredited hospital pharmacies are permitted to engage in the restocking of drugs in accordance with the stipulations identified in the policy. Due to provincial regulation, community pharmacies are currently not able to engage in the restocking of drugs. Currently, the Drug and Pharmacies Regulation Act, DPRA, O. Reg. 264/16, s.32 permits the restocking of drugs (subjection to the conditions in the regulation) in an accredited hospital pharmacy environment. The DPRA, O. Reg. 264/16, s.32 prohibits an accredited community pharmacy returning to stock, reselling or redispensing a Schedule I drug that was previously sold or dispensed.
The O. Reg 130/17 of the Pharmacy Act considers it “professional misconduct” to return to stock, resell or redispense a Schedule I drug that was previously sold or dispensed. Therefore, registrants must only engage in restocking for MAID drugs under the authority of the accredited hospital pharmacy where the pharmacy has established this practice as permitted through the DPRA, O. Reg. 264/16, s.32.
It is the College’s expectation that the accredited hospital pharmacy ensures that the drug has been in the possession of a licensed healthcare professional at all times (from time of dispensing to time of return to the pharmacy). If the drug has left the possession of a licensed healthcare professional, even for a short period of time, the drug integrity cannot be verified and restocking is not permitted. The licensed healthcare professional who has been in possession of the drug should confirm that the drug has been stored in accordance with the manufacturer’s requirements (e.g. appropriate temperature, etc.).