CPSO Board Approves Changes to Safer Supply Prescribing Expectations

Safer supply involves prescribing pharmaceutical-grade short-acting opioids (e.g., hydromorphone) to patients with substance use disorder who are at high risk of overdose as a safer alternative to the toxic supply of illicit drugs. Opioid agonist treatment (OAT) involves prescribing medications (e.g., methadone, buprenorphine) to prevent withdrawal and lower cravings in patients with opioid use disorder. Usually, the goal of traditional OAT is for a patient to stop taking drugs, whereas the goal of safer supply is harm reduction. Both approaches should strive to connect patients with other health and social services.

Not at this time. While the CPSO changes are not prescriptive about which regulated healthcare professionals are permitted to observe consumption of safer supply, OCP’s existing Opioid Policy expects pharmacists providing opioid agonist treatment (OAT) to practice in accordance with the Centre for Addiction and Mental Health (CAMH) Opioid Agonist Maintenance Treatment: A Pharmacist’s Guide to Methadone and Buprenorphine for Opioid Use Disorder and the Standards of Practice. The pharmacist is responsible for the therapeutic check of the prescription, assessing the patient, and witnessing the patient taking their dose of OAT. These functions cannot be delegated or assigned to a pharmacy technician. Currently, this restriction on observed dosing applies to safer supply medication following the CPSO’s prescribing policy changes until such time that the College has completed its policy review.

The CPSO’s policy changes indicate that a regulated health professional in Ontario can observe a patient taking their dose of safer supply medication. They are not prescriptive about which healthcare professionals can witness consumption, therefore each health profession regulator in Ontario must consider whether there is a need to articulate the appropriate role for that profession in the witnessing of safer supply medication dosing. For example, a registered nurse employed by a pharmacy would consult the College of Nurses of Ontario for guidance.

The College’s Opioid Policy expects pharmacists providing opioid agonist treatment (OAT) to practice in accordance with the Centre for Addiction and Mental Health (CAMH) Opioid Agonist Maintenance Treatment: A Pharmacist’s Guide to Methadone and Buprenorphine for Opioid Use Disorder, in which the pharmacist is responsible for witnessing the patient taking their observed dose. Assigning this responsibility to another regulated health professional should be done in collaboration with, and under the direction of, the prescribing physician. 

With the CPSO changes, safer supply medications are to be dispensed with “no carries”, therefore witnessing consumption would take place in-person where the medication is dispensed. Virtually witnessing the patient take their dose is not the intention of the CPSO policy change and is not permitted at this time.

The College is actively assessing whether changes to its existing policies are required to align with CPSO’s updated Prescribing Drugs Policy. We are also actively collaborating with system partners, such as CAMH, to be consistent with best practices in opioid dispensing including safer supply and harm reduction services in our communities. The College expects to bring all relevant policy updates to the Board for their approval in December. Until then, registrants are reminded to follow all existing policy expectations. Registrants can follow e-Connect for new information and are reminded to check the Board materials package that will be posted approximately two weeks prior to the Board meeting being held on Dec 7, 2026.

Not all pharmacies are expected to provide all pharmacy services. Designated managers should assess whether their pharmacies can safely support additional observed dosing activities. This includes consideration for: 

• Availability of pharmacist to witness a patient taking their observed dose
• Availability of pharmacy staff resources to support observed dosing, such as assisting with documentation and managing waiting patients
• Physical space requirements to accommodate increased patient visits
• Hours of operation and their impact on patients requiring observed dosing daily or more than once a day
• Privacy, and safety considerations associated with on-site observed dosing

If the pharmacy cannot provide these services safely, the College’s expectation is that the patient’s care would be transitioned to another pharmacy that can safely and appropriately meet their needs (Code of Ethics – Standard 2.15).

As with all medications, pharmacists are expected to maintain communication with prescribers to ensure appropriate management of missed doses, interruptions in therapy, or safety concerns. Regardless of the prescribing framework, pharmacists remain responsible for:

• Assessing the appropriateness and safety of prescriptions
• Identifying and addressing potential medication-related risks
• Communicating concerns to prescribers when clinical, operational, or patient-safety issues arise

These changes apply to all prescriptions for safer supply medications dispensed in Ontario, as of November 16, 2026. Collaboration with an out-of-province prescriber may be required to ensure a safer supply prescription is dispensed in accordance with Ontario policies and the Narcotic Safety and Awareness Act.

As always, when determining whether to dispense a prescription a registrant must evaluate the prescription as a whole. In addition to assessing the prescriber’s method of authorizing the prescription, registrants must consider the content of the prescription and its appropriateness, given the patient’s condition and prescription history. If, upon assessing the prescription as a whole, registrants are unsure of a prescription’s authenticity or appropriateness it is the responsibility of the registrant to confirm the prescription with the prescriber (see Authenticity of Prescriptions using Unique Identifiers for Prescribers Position Statement on the OCP website).

If the prescription is missing the indication and direction for “no carries”, pharmacists are expected to exercise their professional judgment to decide if confirmation with the prescriber is required prior to implementing the CPSO expectation that medication dispensed for safer supply be witnessed when ingested.

Additionally, the College has provided a response to the question: Can we accept prescriptions for methadone for MMT from out of province clinics/prescribers?

Existing prescriptions on file with part-fills or refills remaining can be dispensed, however any prescriptions issued after November 16, 2026, are be expected to meet the new policy expectations (i.e. indicating that the prescription is for safer supply and noting “no carries” to support witnessed dosing).