On October 1, 2026, the new Controlled Substances Regulations (CSR) will come into effect which will impact Nurse Practitioners (NPs) and midwives who practice in hospitals.
The new CSR will consolidate the Narcotic Control Regulations, the Benzodiazepines and Other Targeted Substances Regulations, Part G and J of the Food Classes of Practitioners Regulations and six class exemptions, providing a single framework for all controlled substances. It will govern activities involving four categories of controlled substances; narcotics, controlled drugs, targeted substances (including benzodiazepines) and restricted drugs.
There are several key changes that impact both NPs and midwives who practice in hospitals. These changes should be interpreted within the context of employer policy.
- Safeguards and Documentation requirements: The CSR outlines enhanced requirements for record-keeping, retention and reporting, including new requirements related to post-consumer returns (unused or expired controlled substances returned by clients). NPs and midwives who practice in hospitals will be required to issue a written prescription prior to selling or providing a controlled substance, other than a restricted drug, to an individual.
- Expanded authority for returns and destruction: In specific circumstances, NPs and midwives who practice in hospitals will be authorized to destroy post-consumer returns of controlled substances and to sell or provide returned substances to a licensed dealer or the Minister.
- Authorization to verbally prescribe continues: The changes made during COVID to allow practitioners to verbally prescribe controlled substances are now incorporated in the CSR. Authorized prescribers should write medication orders whenever possible.
There are additional changes that apply only to NP practice:
- New transportation and storage requirements: NPs will need to meet new requirements to send, deliver, transport, and store controlled substances.
- Prescribing authority: NPs will be authorized to prescribe opium and coca leaves. NPs who wish to prescribe them must apply for special access through the Health Canada Special Access Program.
The new CSR do not impact midwives and NPs’ obligations under Nova Scotia’s Prescription Monitoring Program.
In accordance with NSNMR policy, midwives may only prescribe and administer controlled drugs and substances in hospitals and are not authorized to:
- transport or store controlled drugs and substances, or
- prescribe or administer them in community sites of practice or clients’ home.
NSNMR is working to revise any relevant guidance documents as necessary. Please reach out to practice@nsnmr.ca if you have any questions.
