Changes to Coverage of Methadone Concentrate Products
Manitoba Health and Seniors Care (MHSC) has released Bulletin #112; effective August 5, 2021, generic methadone products are listed as a Part 1 (open) benefit. These generic methadone products are NOT interchangeable with each other nor with the brand name methadone products. Pharmacists dispensing methadone should review the updated MHSC methadone Claims Submission Procedure and Background and Frequently Asked Questions, or see the MHSC page here.
Brand name methadone concentrate products (Methadose, Methadose Sugar-Free and Metadol-D) will be moved from Part 1 benefit to Part 2 benefit for patients who are being treated with the brand name methadone product, or for whom have previously been treated with two or more generic methadone products listed under Part 1.
A safety review completed by Health Canada found that there may be a link between switching methadone-containing products used to treat opioid use disorder and the risk of lack of effect, which may present as withdrawal symptoms, although the reason for this is unclear.
Healthcare professionals should be aware that:
- Some patients may experience withdrawal symptoms after being switched from one methadone-containing product to another; these patients should be clinically managed and monitored regularly.
- Dose adjustments may be necessary in some patients.
- Withdrawal symptoms can lead to a failure to remain in treatment and subsequent problematic substance use, which can lead to serious harm.
Methadone products are not interchangeable from a clinical perspective nor a coverage perspective. A new prescription from an approved prescriber would be required to switch a client from one methadone product to another. If a patient is new to taking methadone and appears at a pharmacy with a prescription that does not specify the brand (i.e., written as “methadone”), the pharmacist can dispense whatever generic is usually used by the pharmacy. It is good practice for the pharmacist to notify the prescriber of the generic brand that is being used. This may be done by fax.
If the patient is already taking methadone and presents with a new script, consideration must be given to what brand the patient has been receiving, and it may be necessary in some cases to avoid changing the brand, if possible. If the patient receives a different methadone brand, the patient and prescriber must be made aware, and arrangements for monitoring and management should be in place. Early withdrawal symptoms can lead to a failure to remain in treatment and subsequent problematic substance use, which may lead to serious harm.
The Opioid Agonist Therapy Guidelines for Manitoba Pharmacists will be updated at the earliest opportunity to reflect these changes.
Recent Reports of Pharmacy Break-ins
The College has been informed of numerous pharmacy break and enters (burglaries) in Manitoba over the last several months. These burglaries typically occurred outside of pharmacy operating hours when no pharmacy staff were present.
The College would like to remind all pharmacy managers of the importance of and their responsibility in protecting the pharmacy premises and drug inventory, including all narcotics, controlled drugs, and targeted substances. Pharmacy managers and staff are encouraged to review their current pharmacy security for areas of improvement and make enhancements where appropriate. This should include a review of the monitored alarm system and video surveillance. It is recommended alarm systems have redundancies in case of power failure or the tampering of phone and power lines. Video surveillance data should be stored in a location that is not easily identifiable. Please ensure that narcotics are stored securely in a locked safe and consideration should be made to carry a minimum level of narcotics as appropriate. Whenever possible, the security of any connected adjacent units should be discussed with the unit owner or landlord, especially if the units are vacant.
Pharmacists are also reminded to report the loss or theft of narcotic, controlled drugs and/or targeted substances within 10 days of discovering, through the Loss or Theft Report Form for Controlled Substances and Precursors found on the College website. This completed report must be submitted to Health Canada – Office of Controlled Substances, and the College.
Aside from contacting police, pharmacy managers are also reminded to contact the College immediately with details of a reported pharmacy burglary. Contact with the College can be via phone at 204-233-1411, fax at 204-237-3468, or email at email@example.com. Please refer to the document on the College website titled, Procedures in the Event of a Robbery or Burglary for more information.
Consultation Closing Today: Pharmacist Prescribing for Uncomplicated Cystitis
Manitoba Health and Seniors Care (MHSC) has advised the College of Pharmacists of Manitoba that it is a priority to implement prescribing authority to pharmacists for uncomplicated cystitis and is proceeding with an amendment to pharmacy practice legislation.
The amendment would add a new subsection, 118(5), to the Pharmaceutical Regulation permitting pharmacists who have completed a training program approved by Council to prescribe a drug specified to treat uncomplicated cystitis in a product monograph authorized by Health Canada.
Today is the final day of the consultation. Please review the draft amendment and further information found on the CPhM website News Page and provide your feedback by email to firstname.lastname@example.org by the end of the day today (July 9, 2021).