Can a pharmacy professional administer a substance that is inhaled through the nose (e.g., flu vaccine, naloxone, etc.) if it is not listed in Schedule 2 of O. Reg. 256/24, without a medical directive?

Yes. A pharmacy professional may decide to administer a substance that is not listed in Schedule 2 of O. Reg. 256/24 to a patient via the intranasal route, without needing delegation of authority (e.g., a medical directive). Refer to Appendix A of the Administering a Substance by Inhalation Guideline as it explains that “intranasal” administration of a substance is not a controlled act and therefore is not restricted to health professionals or require enabling regulations. 

With inhalation, the drug is intended to be delivered to the epithelium lining the lower respiratory tract. With intranasal administration, the drug is intended to be delivered to the mucous membranes lining the nasal passages. If a pharmacy professional decides to administer a substance by the intranasal route, this should still be done in accordance with the Administering a Substance by Inhalation Guideline, Code of Ethics and Standards of Practice.