Guideline 714-2: Safe storage and access to offender medications in community correctional centres

Applies to all staff members and contractors involved in the case management, supervision, and surveillance of offenders residing in CCCs where there is no nursing staff

Contents

• Responsibilities and Procedures
  • Offender Medications
  • Management of Narcotics and Controlled Drugs, Cannabis for Medical Purposes Products as well as Medications Related to a PBC Condition or a Court Order
  • Offender Self-Administration of Medications
  • Methadone/Suboxone
  • Logging of Medications Stored in a Locked Cabinet or in a Safe Location
  • Administration of the EpiPen®
  • Administration of Narcan® Nasal Spray
  • Removal and Disposal of Medications
  • Removal and Disposal of Sharps (Used Needles, Finger Lancets, etc.)
  • Information Management
• Enquiries
• Cross-References and Definitions

Responsibilities and Procedures

Offender Medications

1. The Parole Officer will ensure:
   1. the offender is able to obtain cannabis for medical purposes from distributors licensed by Health Canada in accordance with the applicable provincial/territorial standards
   2. the offender has access to medications that are stored in a locked cabinet or in a safe location, and
   3. all prescription and over-the-counter medications are in their original packaging (e.g., bottle, box, blister pack).

Management of Narcotics and Controlled Drugs, Cannabis for Medical Purposes Products as well as Medications Related to a PBC Condition or a Court Order

2. The CCC Manager will ensure all narcotics and controlled drugs, cannabis for medical purposes products as well as medications related to a PBC condition or a court order are stored in a locked cabinet or in a safe location.
3. All other prescription and over-the-counter medications will be in the offender’s possession.
4. Staff members will consult the local pharmacy:
   1. to determine if an offender’s medications fall within the category of narcotics or controlled drugs, and
   2. to confirm whether the required medications to meet a PBC condition or a court order are available to the offender.

5. Staff members and contractors will:
   1. consult the Log – Access to Medications Stored in a Locked Cabinet or in a Safe Location (CSC/SCC 1679e) to be aware of all offender’s medications that are stored in the locked cabinet or in the safe location, and
   2. manage and control the offender’s access to medications stored in a locked cabinet or in a safe location.

Offender Self-Administration of Medications

6. At no time will an offender be forced to take any medication without their consent.
7. Offenders are responsible to self-administer all their individual prescription and over-the-counter medications.
8. Staff members and contractors are not responsible for the specific requirements regarding offender medications, such as the timing or any reminders to the offender to self-administer their medications.
9. In the event there are reasons to believe that an offender is unable to manage their own prescribed medications, staff members will consult the local pharmacy to determine options that would best assist the offender to safely self-administer their medications (e.g., medications organized in a dosette).
10. If the offender temporarily leaves the CCC, they are responsible for requesting and taking with them the necessary amount of all medications in their possession and those stored in a locked cabinet or in a safe location, for the duration of the expected absence.

Methadone/Suboxone

11. The daily dosage of prescribed methadone, Suboxone, and/or other opioid agonist used in an opioid agonist treatment will be administered at a local pharmacy.
12. In cases where the offender has a prescription of take-home doses of methadone, Suboxone, and/or other opioid agonist used in an opioid agonist treatment, and/or in exceptional circumstances when the offender’s pharmacy is expected to be closed and the CCC is equipped to safely store the medication in accordance with product storage requirements, this medication can be kept on site.
13. Such arrangements must be established in advance through consultation with the pharmacy, the CCC Manager and the supervising Parole Officer, and they must also be documented in a Casework Record.

Logging of Medications Stored in a Locked Cabinet or in a Safe Location

14. For risk management purposes, the Parole Officer will ensure staff members and contractors document, using the Log – Access to Medications Stored in a Locked Cabinet or in a Safe Location (CSC/SCC 1679e), when the offender is provided access to medications stored in a locked cabinet or in a safe location.
15. The offender and the staff member or contractor will sign the Log – Access to Medications Stored in a Locked Cabinet or in a Safe Location (CSC/SCC 1679e) as well as indicate the date and time the offender accesses their medications.
16. The procedure applicable to the management and storage of the Log – Access to Medications Stored in a Locked Cabinet or in a Safe Location (CSC/SCC 1679e) is outlined in Commissioner’s Directive (CD) 228 – Information Management.
17. If the staff member or contractor has any reason to suspect the offender is not taking their prescribed medications as prescribed, the information will be reported to the Parole Officer and necessary action will be taken for risk management purposes.

Administration of the EpiPen®

18. Trained staff members and contractors will administer the EpiPen® as necessary and in accordance with first aid/cardiopulmonary resuscitation training.
19. After the initial administration of the EpiPen®, staff members or contractors will call 911 to have the offender transported to the hospital by ambulance in accordance with CD 800 – Health Services.
20. After the initial administration of the EpiPen®, if the offender shows no improvement within five minutes or if their condition deteriorates before the arrival of emergency medical services personnel, one repeat EpiPen® can be administered (as indicated in the First Aid Manual of the person administrating the EpiPen®). Further information on the EpiPen® may be found in Medication Distribution and Administration Guidelines.

Administration of Narcan® Nasal Spray

21. If an opioid overdose is known or suspected, all staff members or contractors will administer the Narcan® nasal spray, as per the process described in the Protocol: Response by Non-Health Services Staff to Opioid Overdose, to temporarily reverse the effects of an opioid overdose until emergency services arrive.
22. Before administering the Narcan® nasal spray, the staff member or the contractor will call 911 so the offender can be transported by ambulance to the hospital.
23. After the initial administration of the Narcan® nasal spray, if the offender does not respond by waking up, to voice or touch, or breathing normally, an additional dose may be given every two to three minutes, if available, in the other nostril. Whenever necessary, first aid/cardiopulmonary resuscitation will be applied in accordance with the responder’s certification.
24. In an emergency situation resulting in a suspected overdose from the accidental exposure of a staff member, the same response measure with the Narcan® nasal spray will be taken.
25. Further information about the Narcan® nasal spray (including pictures of the device) can be found on the Narcan Canada Website. You can also consult the manufacturer’s Instructions for Use and the video on how to use the Narcan® nasal spray.

Removal and Disposal of Medications

26. Under the direction of the CCC Manager, staff members will send:
    1. unlabelled and expired medications to the local pharmacy for disposal, and
    2. all prescription medications and cannabis for medical purposes products left behind by an offender unlawfully at large to the local pharmacy for disposal, within two weeks. If the local pharmacy does not accept cannabis for medical purposes products, the staff members will send the products to:
       1. the supplier for destruction, or
       2. the regional pharmacy for disposal, along with the Medicinal Marijuana Destruction Within CSC Regional Pharmacies or Health Facilities form (CSC/SCC 1583e).

27. When an offender is arrested following the suspension of their parole or supervision, staff members will, under the direction of the CCC Manager:
    1. package the offender’s over-the-counter medications and:
       1. hand them over to the persons performing the arrest to be delivered to the receiving institution, or
       2. send them directly to the receiving institution
    2. send all the offender’s prescription medications and cannabis for medical purposes products to the local pharmacy for disposal. If the local pharmacy does not accept cannabis for medical purposes products, the staff members will send the products to:
       1. the supplier for destruction, or
       2. the regional pharmacy for disposal, along with the Medicinal Marijuana Destruction Within CSC Regional Pharmacies or Health Facilities form (CSC/SCC 1583e).

Removal and Disposal of Sharps (Used Needles, Finger Lancets, etc.)

28. The CCC Manager will ensure:
    1. sharps, such as needles and finger lancets, are disposed of in an approved biohazard container
    2. the biohazard container is stored in a secure area to which the offender can only have supervised access, and
    3. the biohazard container is sent to the local pharmacy, or another handler of biohazard material, for disposal once it is two-thirds full. At no time will sharps be disposed of into the garbage.

Information Management

29. Policy direction with regard to the management of all related information, records, source documents and data throughout their life cycle will be in accordance with CD 228 – Information Management .

Enquiries

30. Strategic Policy Division

National Headquarters
Email: Gen-NHQPolicy-Politi@csc-scc.gc.ca

Assistant Commissioner,
Correctional Operations and Programs
Jay Pyke

Annex A

Cross-References and Definitions

Cross-References

• CD 001 – Mission, Values and Ethics Framework of the Correctional Service of Canada
• CD 228 – Information Management
• CD 714 – Community Correctional Centre Standards
• CD 800 – Health Services
• Manufacturer’s Instructions for Use of Narcan® Nasal Spray
• Medication Distribution and Administration Guidelines
• NARCAN nasal spray video: Instructions for use
• Regional Pharmacy Services Operations and Standards Manual

Definitions

Access to medications : non-health care professionals provide the offender an opportunity to self-administer medications that have been prepared in advance by an appropriate licensed health care professional.

Dosette : an individualized box containing medications organized into compartments by day and time, so as to simplify the taking of medications (also referred to as bubble pack, strip pack, or compliance pack).

Narcotics and controlled drugs : all narcotics and drugs listed in the Controlled Drugs and Substances Act.

Safe location : a designated secure area within the CCC to which there is no offender access.