Canada Proposes Prescribing Authority for Midwives, Nurse Practitioners

The new regulations proposed by the government of Prime Minister Stephen Harper would allow them and podiatrists to prescribe, administer, and provide legally controlled substances such as codeine, fentanyl, and diazepam.

Canada's national government is proposing new regulations to allow midwives, nurse practitioners, and podiatrists to prescribe some pain-relieving medicines that contain legally controlled substances. Health Canada announced the proposal, with Minister of Health Leona Aglukkaq saying the regulations "will improve flexibility within the health care system and the timeliness of service delivery in Canada. They will promote better continuity of care by removing barriers to access to these medications, where and when they are needed," she added.

As of now, the Controlled Drugs and Substances Act says only medical doctors, dentists, and veterinarians may conduct activities with controlled substances. The proposed New Classes of Practitioners Regulations would authorize midwives, nurse practitioners, and podiatrists to prescribe, administer, and provide legal controlled substances such as codeine, fentanyl, and diazepam (Valium) to treat patients in provinces and territories where they are licensed to do so.

NIH's National Institute on Drug Abuse describes fentanyl as a synthetic opiate painkiller, similar to but more potent than morphine, that is typically used to treat patients with severe pain or to manage pain after surgery. It is a schedule II prescription drug in the United States.

"Because of these new regulations, nurse practitioners will be able to efficiently deliver a more comprehensive level of quality care for which they are trained," said Judith Shamian, president of the Canadian Nurses Association. "Nurse practitioners are poised and ready to deliver an advanced level of care that will reduce wait times and the burden on emergency departments. The time for transformation is now and governments are to be commended when they lead progressive changes such as this one, positively affecting millions of Canadians."

"The designation of midwives as practitioners under the Controlled Drugs and Substances Act is an important first step which we hope will ultimately facilitate midwives having the authority to prescribe a limited number of the appropriate medications for women in their care -- namely medications for pain relief in labor and management of narcotic-induced depression in the neonate", said Kris Robinson, chair of the Canadian Midwifery Regulators Consortium. The government of Prime Minister Stephen Harper said provincial and territorial governments were consulted during the development of the proposed changes.

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