Subsection 56(1) Class Exemption for Primary Care Paramedics, Advanced Care Paramedics and Critical Care Paramedics in Ontario

Pursuant to subsection 56(1) of the Controlled Drugs and Substances Act (CDSA), paramedics with the title of Primary Care Paramedics, Advance Care Paramedics or Critical Care Paramedics in the province of Ontario employed by certified ambulance service operators under the Ambulance Act (Ontario) are exempted for medical purposes from the application of the following provisions of the CDSA and its regulations:

  • Subsection 4(1) of the CDSA with respect to fentanyl, hydromorphone, ketamine, morphine and pethidine;
  • Subsections 5(1) and 5(2) of the CDSA with respect to diazepam, fentanyl, hydromorphone, ketamine, lorazepam, midazolam, morphine and pethidine;
  • Subsection 8(1) of the Narcotic Control Regulations with respect to fentanyl, hydromorphone, ketamine, morphine and pethidine; and
  • Subsection 2(1) of the Benzodiazepines and Other Targeted Substances Regulations with respect to diazepam, lorazepam and midazolam.

In respect of this exemption,

  • Base Hospital Program means a program defined as a Base Hospital Program under the Ambulance Act (Ontario) and Ontario Regulation 257/00.
  • Controlled substance means one of the following substances: diazepam, fentanyl, ketamine, lorazepam, midazolam, morphine and pethidine.
  • Designated Administrator means a person who is in a managerial position and is responsible for ordering, transporting, storing and providing controlled substances to affected paramedics for an ambulance service operator certified under the Ambulance Act (Ontario).
  • Medical Director means a person who is defined as a Medical Director under the Ambulance Act (Ontario) and Ontario Regulation 257/00, and who is ultimately responsible for activities conducted by paramedics with respect to controlled substances.
  • Paramedic means a person who is registered by the Ontario Ministry of Health and Long-Term Care under the Ontario Regulation 257/00 to practice paramedicine as a Primary Care Paramedic, an Advanced Care Paramedic or Critical Care Paramedic in Ontario and administer controlled substances as part of the practice of paramedicine, and authorized by a Medical Director of a Base Hospital Program to practice paramedicine for that Base Hospital Program.
  • Unserviceable stock means drug product containing a controlled substance that is unusable, expired and/or that cannot be dispensed. 

This exemption provides the aforementioned paramedics with the authority to possess, transport, administer and destroy controlled substances when providing pre-hospital care to patients within their scope of practice as set out in the Ontario Regulation 257/00, the Advanced Life Support Patient Care Standards established by the Ontario Ministry of Health and Long-Term Care, and subject to the terms and conditions of this exemption.

The exemption is only applicable if the following conditions are met. Paramedics must:

  1. Administer controlled substances in accordance with the direction of a Base Hospital Program physician and/or the Advanced Life Support Patient Care Standards established by the Ontario Ministry of Health and Long-Term Care;
  2. Record all transactions involving controlled substances, i.e., date, name and quantity of controlled substances obtained, administered, returned, or destroyed, and provide such a record to the Designated Administrator for record-keeping purposes;
  3. Take necessary steps, in accordance with guidelines established by the Ontario Ministry of Health and Long-Term Care and the Medical Director of a Base Hospital Program, to ensure the security of the controlled substances on their person and in their ambulance or aircraft;
  4. Report immediately to the Designated Administrator of the ambulance service operator with which they are affiliated, when they become aware of any loss or theft of controlled substances in their possession or in their ambulance or aircraft;
  5. Dispose of any unserviceable stock in accordance with the direction of the Medical Director of a Base Hospital Program with which they are affiliated with respect to witness and record-keeping; and
  6. Obtain controlled substances from the Designated Administrator of the ambulance service operator with which they are affiliated, or from a pharmacy in accordance with specific instructions and orders by a Medical Director of the Base Hospital Program with which they are affiliated.

This exemption replaces the "Section 56 Class Exemption for Advanced Care and Critical Care Paramedics in Ontario" that was issued on July 12, 2010. This exemption will remain in effect until the date on which this exemption has been replaced or the date on which this exemption is revoked.

The Minister may at any time and for any reason revoke or change the terms and conditions of this exemption. Should this be the case, you will be informed in writing and reasons for the revocation or changes will be provided.

A suspension of this exemption without prior notice may be ordered if the Minister deems that such a suspension is necessary to protect public health, safety or security.

Failure to comply with the terms and conditions of this exemption may, among other things, result in immediate suspension of this exemption, and ultimately, in its revocation.

Signed for and on the behalf of the Minister of Health


Michelle Boudreau
Director General
Controlled Substances Directorate
Health Canada

Effective Date:  May 16, 2019

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