The fentanyl patch-for-patch program has been an old concept that has taken mainstream spotlight (since around 2014).
As always, Behind the Counter helps you understand the key concepts and provide you with practical tools for implementation.
Understanding Patch4Patch (ONTARIO) - The fentanyl patch-for-patch program (where a patient can only receive the same number of new patches as the used patches they have returned to their doctor or pharmacist) has been an old concept that has taken mainstream spotlight (since around 2014).
Now, starting October 1st 2016, in Ontario, there will be mandatory requirements from both dispensers (such as Pharmacists) and prescribers (such as Doctors) to organize and implement a province-wide patch-for-patch program (“P4P” for short).
As always, Behind the Counter will help you understand the key concepts and provide you with practical tools for your success.
1) Ontario College of Pharmacists - Patch-For-Patch Fentanyl Return Program: Fact Sheet
2) Ontario Law https://www.ontario.ca/laws/statute/15s33 and https://www.ontario.ca/laws/regulation/160305
3) Notice from the Executive Officer: Regulation to support the Safeguarding our Communities Act, 2015 (Patch for Patch Return Program) http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/exec_office_20160916.pdf
4) Frequently Asked Questions for Prescribers and Pharmacists http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/fq_exec_office_20160916.pdf
5) Frequently Asked Questions for Patients
Question: Can patients opt out of this P4P program?
Question: Can I (the Pharmacist) opt out?
Question: Is there reimbursement to the Pharmacist or pharmacy?
Answer: No (FYI, physicians get zero reimbursement as well)
Question: What are my (Pharmacist’s) main duties in this mandatory P4P program?
Answer: See summary sheet below...use at own risk!
***Summary updated Sept 28 2016
Question: How should I contact prescribers if I have dispensed a number of patches different than what was prescribed or returned to me?
Answer: Via fax, using a form like the one below...use at own risk!
****Form updated SEPT 28, 2016
I’ve heard numerous reasons for the reason this law is in effect, not limited to concepts such as diversion and/or resale, dangers to pets and children of used patches and also theft of used patches from the garbage. I’ve also heard reasons this law shouldn’t exist, as “street” fentanyl is mostly imported overseas, and that border control would be a better solution. I don’t work for the police or the health ministry, so I wouldn’t be able to verify any of the above reasoning. What does concern me is the challenge of implementation and the complete lack of reimbursement for this mandatory service. No doubt, the month of October may be very frustrating for pharmacy staff. I can only imagine a lot of patients saying “Why do I have to return my dirty old patches? Don’t you trust me? Doesn’t my doctor trust me? I’m not a criminal.” I can understand and empathize with patients who feel there might be some distrust looming in the air, as patients have never been required by law to return medication after they’ve finished using it. Some patients may feel stigmatized too.
As for the reimbursement, prescribers and dispensers all have additional procedures to follow, with additional documentation. There should be some form of reimbursement, and I encourage you to send an email to three parties asking why there wasn’t:
Ontario Pharmacists Association: firstname.lastname@example.org
Your local Member of Parliament (M.P): http://www.lop.parl.gc.ca/ParlInfo/compilations/houseofcommons/memberbypostalcode.aspx?Menu=HOC
Your local Member of Provincial Parliament (M.P.P): http://www.ontla.on.ca/web/members/members_current.do?locale=en&ord=Riding&dir=ASC&list_type=all_mpps
I prefer to end this blog post with some hope and enthusiasm. Time will tell if our government and regulatory colleges are correct about this program’s impact on illicit fentanyl. In the meantime, if you’re a pharmacist who has patients using fentanyl, the next few months could be a great time to open up another dialogue about its risks. I would expect a lot of pushback at first, but this type of change doesn’t happen immediately but you can be the catalyst they need.