In the midst of a primary health care crisis, B.C.'s Minister of Health announced broad changes that expand the scope of practice for pharmacists in British Columbia. These changes ranged from being able to adapt and renew prescriptions for more medications to lifting restrictions on injections, which began on Oct. 14, 2022.
At his announcement in September 2022, Minister Adrian Dix directed plans to allow pharmacists to be able prescribe for minor ailments and contraceptives by spring 2023.
By Angie Gaddy
Communications Director, BCPhA
Jamie Wigston (West End Medicine Centre, New Westminster)
Pharmacists in British Columbia have been asking for expanded scope of practice for more than a decade — pointing to other provinces that allow pharmacists to prescribe like Alberta and Saskatchewan. Ontario is set to implement pharmacist prescribing for minor aliments in January 2023.
“Ask anyone and they’ll always say, ‘We want what Alberta has,’” says Jamie Wigston, president of the BC Pharmacy Association. “This is an exciting time to be a pharmacist in B.C.”
As part of the changes, restrictions on which medications could be administered via injection or intranasally by pharmacists have been lifted.
Pharmacists can now administer medications like B12 shots, anti-psychotics and other medications through injection as long as a patient has a prescription. What is excluded are cosmetic drugs and substances or allergy serums.
While the injection fee for these other medications now sits at $11.41, the same fee as physicians, the Association will continue to advocate for increased renumeration.
“Pharmacists have been key during COVID-19, ensuring British Columbians have been able to get their COVID-19 vaccines and flu shots. Pharmacists have consistently demonstrated our commitment to public health, and we should be very proud of that,” Wigston says.
Mona Kwong (Pharmasave #87, Vancouver)
Mona Kwong was one of the first 12 injection trainers when B.C. pharmacists gained the authority to administer injections in 2009.
Over the years, she’s seen the shift in attitudes of pharmacists, the public and other health-care care providers around pharmacists administering injections.
“Back in 2008 (when training began) people were awkward about touching,” Kwong says, “Now, look how many pharmacists and pharmacies are giving different types of vaccines over the years.”
Kwong is currently reworking her Vancouver pharmacy’s office to accommodate further injections and expanded scope.
“I’m so excited,” she says. “I see so much potential right now.” One of her team members charged their first shingles vaccination administration fee days after the Oct. 14 change. Another patient was having difficulty getting in for a B12 injection with a doctor but was able to book an appointment to have it done at her pharmacy. In the future she sees the ability to provide patients with testosterone injections or their psychiatric injections.
Previously nurses were injecting anti-psychotics for patients. Now Kwong sees team-based care.
“I’m hoping we merge together more as groups. There’s only so much one person can do. We need to do it together. Because the health care system has to change,” Kwong says. “And it’s changing.”
Prescription adaptation and renewals
With nearly 1 million British Columbians without a family physician, Minister Dix announced a health human resources strategy that included “optimizing the scope of pharmacists.”
Within a few weeks, this meant pharmacists could renew and adapt medications for all ongoing conditions, except for cancer chemotherapy, for up to 24 months from the original prescription date. Previously, mental health and cardiac medications — some of the most common medications — could not be renewed or adapted by pharmacists.
Additionally, for patients who don’t have access to a prescriber or have difficulty in accessing one, pharmacists are being encouraged to expand the length of emergency supplies when appropriate. Depending on the patient’s specific situation that could be up to 90 days of an emergency supply.
“What we don’t want to see happen is patients going into the emergency department for prescription renewals. We are in a primary health care crisis, and it makes no sense for individuals to have to sit hours in an ER waiting for a prescription,” Wigston says.
“Pharmacists have the knowledge and the training to provide these clinical services and can deliver them well.”
Justin Dovale (Two Nice Guys Pharmacy, Kelowna)
For Pharmacist Justin Dovale, allowing adaptation and renewals for more medications means helping patients with opioid use disorder stay stable on their medications.
Dovale, who co-owns Two Nice Guys Pharmacy in Kelowna, found that even if patients were stable and motivated to stay on Opioid Agonist Treatment (OAT), they may miss an appointment or miss a couple of days of treatment. This meant they may have to visit a prescriber to restart treatment, and potentially deal with withdrawal symptoms, or a relapse and the risks associated with using illicit substances. But with the recent changes to PPP-58 that allows him to renew OAT prescriptions, his patients can remain stable.
“Renewals really support continuity of care,” he says. Many patients on OAT are also on other psychiatric medications for mental health. Allowing pharmacists to adapt and renew these medications, ensure patients stay healthy.
For many patients on OAT, they are also taking psychiatric medications for mental health. Allowing for adaptations and renewals for those have been key to helping continuing care.
Within the first week, Dovale’s team was adapting and renewing prescriptions for mental health medications and Opioid Agonist Treatment.
“We noticed an immediate impact.”
Pharmacist prescribing on the horizon
For pharmacists like Fairuz Siraj of Victoria, having future of prescribing for minor ailments and contraceptives is what he was trained to do.
A 2019 graduate of UBC’s Faculty of Pharmaceutical Sciences, Siraj has longed to join the ranks of his colleagues in other provinces.
“Those of us who are new practitioners are excited about practicing to the fullest scope possible. We’ve have wanted this since starting pharmacy school,” he says.
The Minister of Health gave a directive that work should begin so that pharmacist prescribing for minor ailments and contraceptives should be in place by the spring of 2023. That means the BC Pharmacy Association will work with the College and Ministry of Health on what the future looks like for pharmacist prescribing in B.C.
Fairuz is quick to point out that expanded scope for pharmacists doesn’t mean taking away roles from prescribers. What it means, is that physicians, nurses, and nurse practitioners are able to bring their expertise to patients to provide the best care.
“Now we’re all on the same team,” Siraj says. “There’s a lot of work to be done, but it’s exciting to see the Association do this.”
Fairuz Siraj (Pharmasave #142, Victoria)
The news that B.C.’s pharmacists would soon join their counterparts in other provinces able to prescribe for minor ailments made Victoria Pharmacist Fairuz Siraj proud.
“I’ve always felt privileged to be a pharmacist,” Siraj says. “Now we have this rejuvenated pride again. The mind shift has changed. We get to have a direct impact on the next 100 years.”
On Sept. 29, Minister Dix announced work should begin to allow pharmacists to prescribe for minor ailments and contraceptives by the spring of 2023.
For Siraj, this shift should give pharmacists the confidence in themselves both in the work environment and as a member of the health-care team.
Like others in health care, pharmacists have been burned out from working long hours during the pandemic, and there are job openings across B.C. Some are worried and not sure what the future means.
"But I’m pumped. You can create your own role. You can create what you want. Because of this expanded scope you have way more opportunities," Siraj says.
Siraj is excited about the planning stages, knowing there’s a lot of work to be done.
“The last thing we want to see is not a lot of uptake,” he says. “At the end of the day you have to have the courage to make the best of this opportunity.”