A Prescription for Action: A Pan-Canadian Strategy for Advancing the Appropriate Use of Prescription Medications

On this page

1. 1. Foreword
2. 2. Introduction
3. 3. How we developed this strategy
4. 4. Purpose, goals, and guiding principles
5. 5. Strategic priorities
6. 6. Conclusion
7. Appendix 1
8. References

Canada's Drug Agency

Canada's Drug Agency is a pan-Canadian health organization created and funded by Canada's federal, provincial, and territorial governments.

We are responsible for driving public value, better coordination, and alignment across the drug, health technology, and health systems landscape. We provide independent evidence appraisal and advice to health system leaders, empowering them to make informed decisions about drugs, health technologies, and broader health system strategies and investments.

In collaboration with national and international partners, we amplify our collective impact on health care.

1. Foreword

Co-Chairs' Message

Prescription medications are an important part of how people manage their health. More than half of adults in Canada take at least 1 prescription medication each month. Using medications appropriately helps people stay as healthy as possible, with the least risk of harm.

This pan-Canadian strategy outlines how many partners will work together to improve appropriate use over the next 5 years. It rests on the work of 2 committees. We have been privileged to serve both.

In 2023, Health Canada's Canadian Drug Agency Transition Office (CDATO) established an Appropriate Use Advisory Committee. The committee's final report provided recommendations for a strategy to improve appropriate use in Canada. That committee has now dissolved.

When Canada's Drug Agency (CDA-AMC) established its Appropriate Use Advisory Committee in 2024, we were honoured to co-chair it. With our fellow committee members, we validated and refined the elements in the final report produced by Health Canada's CDATO Appropriate Use Advisory Committee. We provided advice to CDA-AMC as the organization developed further details of the strategy.

We also received invaluable feedback from people across Canada, including federal, provincial, and territorial governments; a group of Indigenous health care professionals, including members of the Indigenous Pharmacy Professionals of Canada; patient organizations; equity-deserving populations; industry; and health system partners, including prescribers.

Thank you to all who shared their perspectives, provided input, and asked questions. We also extend our gratitude to both Appropriate Use Advisory Committees for their efforts and expertise.

Developed collaboratively, this strategy will be implemented collectively. Reaching our shared destination will require many partners across Canada, who are already committed to improving the prescribing and use of medications.

Over time, new learning and new evidence may bring new ways to improve appropriate use. That means that this strategy will evolve alongside those it serves.

Throughout our time on Health Canada's CDATO and the CDA-AMC Appropriate Use Advisory Committees, we have heard stories that highlight the deeply personal nature of this work and calls for action that underscore its urgency.

Appropriate use impacts us all.

The time has come to act, for all.

Stephen Samis

Co-chair, CDA-AMC Appropriate Use Advisory Committee

Dr. James Silvius

Co-chair, CDA-AMC Appropriate Use Advisory Committee

2. Introduction

Prescription medications are an important part of how people manage their health. However, to bring the most benefit to people, communities, and health systems, medications need to be prescribed and used appropriately. Evidence shows that when medications are not used appropriately, there may be harms for individuals, including negative effects on their health, hospitalizations, and even death.

On December 18, 2023, the Government of Canada announced that Canada's Drug Agency (CDA-AMC) would be built from the Canadian Agency for Drugs and Technologies in Health (CADTH). The creation of CDA-AMC added new areas of work to the organization, including improving the appropriate prescribing and use of medications. As stated in the Pharmacare Act, 1 part of this work is the development of a pan-Canadian strategy for the appropriate use of prescription medications.

CDA-AMC's A Prescription for Action: A Pan-Canadian Strategy for Advancing the Appropriate Use of Prescription Medications (the Appropriate Use Strategy) is a 5-year plan to advance the appropriate use of prescription medications in Canada. This strategy aligns with CDA-AMC's strategic plan and broader mandate, while guiding efforts to support partners (including governments, organizations and groups working in appropriate use, and many others) working to improve how medications are prescribed and used in Canada. With a pan-Canadian approach, this strategy will harness and elevate their work for greater collective impact.

As such, this strategy is about how CDA-AMC will support and guide pan-Canadian action by working with partners across the country to drive change that will support patients, caregivers, and the public; health care providers; and the health system. This strategy is not guided by cost or intended to limit patient choice, and it does not weigh in on the appropriateness of specific medications.

The Appropriate Use Strategy builds on the recommendations of the final report of the Appropriate Use Advisory Committee at Health Canada's Canadian Drug Agency Transition Office (CDATO), titled A Path to Improving Medication Appropriateness in Canada.

Among its other findings, that report simply — and strikingly — stated, "Action is required."

This strategy answers that call.

What is the appropriate use of prescription medications?

Appropriate use is when patients, caregivers, and health care professionals work together to choose safe and effective medications most suited for that person's needs and goals to achieve best health outcomes. Using medications appropriately adds value to an individual's well-being, and to communities, health systems, and the broader environment. The appropriateness of a given medication depends on the person taking it, and their circumstances at the time. A medication that is appropriate for one person may not be right for another. The appropriateness of a medication for a person can also change over time due to factors like aging, other illnesses, or changes in a health condition. While over-the-counter medications and nondrug treatments are also important parts of managing health, this strategy is about the appropriate use of prescription medications.^{Footnote *}

What is inappropriate use?

By improving the appropriate use of medications, we can also reduce their potentially inappropriate use. Inappropriate use can be grouped into several broad categories:

Overuse: This occurs when a person is prescribed medications that they do not need, that offer little value, and/or that are likely to cause more harm than benefit for that person.

• For example: Antibiotic use for viral infections would be considered overuse, given that antibiotics do not work on viruses. Using antibiotics for viral infections will not help a person get better, and it can contribute to antimicrobial resistance (i.e., antimicrobials become less effective).^{Footnote 2}

Underuse: This occurs when a person is not prescribed a medication potentially available to them that could offer them a benefit, or the medication prescribed is not sufficient for the person's needs.

• For example: Statins can be underused in reducing the risk of illness in people at higher risk of cardiovascular disease. Statins lower cholesterol, which has been shown to help people prevent and survive cardiovascular disease.^{Footnote 3}

Inappropriate use: This is an umbrella term that can include overuse and underuse. It can also include other kinds of medication use that do not adequately address the care and priorities of the person.

• For example: Long-term use of benzodiazepines to improve sleep, when they are intended for short-term use, would be considered inappropriate use. When used long-term, benzodiazepines can lead to harms like memory problems, falls and injuries, and dependence (making it harder to stop or reduce the amount of medication).^{Footnote 4}

Why we need a pan-Canadian appropriate use strategy

Many people in Canada take prescription medications. As Canada's population grows and ages, and as more people live with more complex health needs, the number of people taking prescription medications will increase. This means that efforts to improve appropriate use will continue to have increasing impacts for people in Canada.

In Canada:

• 55% of adults and 23% of children take at least 1 prescription medication each month.^{Footnote 5Footnote 6}
• 9 million people aged 65 years and older regularly use at least 1 potentially inappropriate medication.^{Footnote 7}
  • Potentially inappropriate medications may do more harm than good for a person. Possible harms may include side effects, interactions with other medications, falls and fractures, or hospitalizations.
• More than 1 in 5 adults aged 40 to 79 years take 5 or more prescription medications.^{Footnote 8}
  • While taking 5 or more prescription medications may be necessary and appropriate for some people, evidence also shows that it is linked to higher rates of adverse drug events and other health problems.^{Footnote 9}

The impacts of inappropriate medication use extend beyond an individual's health. In 2021, people in Canada spent $1 billion on potentially inappropriate medications.^{Footnote 10}

Many partners across the health system are working to improve the appropriate use of medications, with programs and initiatives in place at the pan-Canadian and provincial and territorial levels. More than 50 existing appropriate use organizations, programs, and initiatives in Canada were documented in the final report of Health Canada's CDATO Appropriate Use Advisory Committee.^{Footnote 11} However, as that report notes, these initiatives often operate with little coordination, which limits their reach and impact.

The issue this strategy will address

As these data show, taking a pan-Canadian, collaborative approach toward improving appropriate use could have benefits for many people in Canada, and more importantly, avoid harms.

Pan-Canadian expertise and partnerships can be brought together to create a healthier future for people in Canada through evidence and collective efforts. In this future, more people in Canada use medications in ways that improve and maintain their health. More health care providers have the tools they need to support appropriate medication prescribing, use, and management for their patients. Additionally, appropriate use organizations across Canada have support and coordination to help as many people as possible.

This strategy is intended to realize that future, starting today.

3. How we developed this strategy

Origins: Health Canada's CDATO Appropriate Use Advisory Committee

Appropriate use has long been a priority for the provinces and territories. In March 2023, Health Canada's CDATO Appropriate Use Advisory Committee was convened to support the development of this strategy.

More than 200 participants across Canada shared their views on the committee's interim report. After publishing its final report in July 2024, the committee was dissolved.

Evolution: CDA-AMC Appropriate Use Advisory Committee

The CDA-AMC Appropriate Use Advisory Committee held 7 meetings between September 2024 and May 2025 to refine key strategic elements developed by Health Canada's CDATO Appropriate Use Advisory Committee, along with additional elements proposed by CDA-AMC.

Refer to Appendix 1 for a full list of committee members.

Refinement: Broad consultation

CDA-AMC shared draft elements of the Appropriate Use Strategy with a wide range of interested parties. Ten virtual small-group discussions and an open-registration virtual town hall were held in January 2025 and February 2025. More than 250 individuals were engaged, including representatives of:

• appropriate use organizations
• CDA-AMC advisory committees
• equity-deserving populations
• federal, provincial, and territorial governments
• health system partners (prescribers and other clinicians, health care organizations)
• a group of Indigenous health care professionals, including members of the Indigenous Pharmacy Professionals of Canada
  • We held an engagement session with a small group of Indigenous health care professionals who shared ideas about how to build relationships and collaborate with CDA-AMC Appropriate Use initiatives. The inclusion of representatives from First Nations, Inuit, and Métis communities was extremely important.
  • Still, we highlight that more robust engagement (e.g., with more participants and diverse representation from different geographic regions) is required to state that a distinctions-based approach representing those communities was achieved. Using feedback from such a small sample size and without following appropriate Nation-specific or community-specific protocols risks perpetuating dangerous homogenization of these groups. Each person spoke as an individual, representing their own life experiences, values, and understanding, and did not claim to be the voice to represent their whole Nation or community. This joint statement was developed by the Canadian Medication Appropriateness and Deprescribing Network Indigenization Working Group.
• industry
• patients, caregivers, and the public.

During these discussions, we heard the following:

• Appropriate use matters to people in Canada: Participants were enthusiastic about providing input, asking questions, sharing their perspectives, and staying connected to this work. All groups highlighted the importance of appropriate use for patients and health systems.
• Our work begins with trust: Precisely because appropriate use matters so deeply to people in Canada, building trust with partners across health systems (including patients and prescribers) will be key to the Appropriate Use Strategy's success. Trust in the evidence behind our resources, trust in our relationships with interested parties, and trust in the Appropriate Use Strategy itself will support the development, use, and sharing of appropriate use resources.
• Communication will play a key role: CDA-AMC will need to clearly communicate what appropriate use means, how we will be advancing this strategy, and who it will impact. In particular, CDA-AMC should consider how to best reach patients, caregivers, and underserved and equity-deserving populations.
• People want to know what success looks like: Participants expressed strong interest in understanding what the Appropriate Use Strategy aims to achieve, what CDA-AMC will measure to make sure that it is on the right track, and how we can measure outcomes as well as processes.

4. Purpose, goals, and guiding principles

What we want to achieve

To map our journey effectively, we need to know our destination. As we implement this strategy, these are the aspirations we want to see realized.

For Patients, Caregivers, and the Public

Patients, caregivers, and the public have a better understanding of appropriate use. They feel more confident when asking questions and making decisions about their medications. Their medication use supports their health, wellness and what matters most to them. Fewer people are harmed by inappropriate medication use.

For Health Care Providers

Health care providers are better equipped with evidence-based tools and resources to make informed decisions about prescribing and to have conversations with their patients about medication use. They feel more supported in their work, they know what resources are available to them, and they know where to go for more information.

For Health Systems

Appropriate use organizations and other partners work together in a more coordinated way, elevating — not duplicating — each other's work. Promising appropriate use practices reach more people in Canada and have greater impacts.

Health system decision-makers use CDA-AMC evidence and information to support appropriate use initiatives and policies in their jurisdictions. Their existing investments have more impact as more people get higher-value care, aligned with the Quintuple Aim (better health outcomes, improved patient experience, improved provider satisfaction, more cost-effective care, and improved health equity).

Achieving these outcomes rests on the following purpose, goals, and guiding principles.

Purpose: What drives our work

Our purpose is to connect and empower partners who are helping people make evidence-informed choices about the appropriate use of prescription medicines and related products.

Goals: Our key objectives

• Support the public, patients, and caregivers to make informed choices about medication use that are developed with them and prioritize their personal goals and values.
• Equip clinicians with evidence-informed tools to support appropriate prescribing.
• Support policy-makers and decision-makers in implementing evidence-informed appropriate use policies and programs.
• Strengthen health system sustainability through collaborative efforts to support appropriate use practices.
• Collaborate with partners across the health system to support appropriate use practices, understanding, and awareness.

Guiding principles

Supporting these key objectives, 6 principles guide the Appropriate Use Strategy. These principles have been refined from the guiding principles recommended by Health Canada's CDATO Appropriate Use Advisory Committee.

• Person-centred: Focuses on the care, safety, and priorities of people and promotes shared decision-making about a person's care.
• Collaborative: Values collaboration and shared accountability with all partners in the health system and those along the care continuum.
• Equitable: Seeks to reduce barriers to appropriate use that hamper opportunities for patients to achieve their full health potential, including socioeconomic, cultural, and environmental barriers.
• Evidence-informed: Applies the best available evidence on interventions and implementation approaches to guide effective change and continuous quality improvement.
• Continuous: Leverages existing efforts to improve appropriate use and supports their coordination, advancement, refinement, and success.
• Sustainable: Strives for solutions that improve resource stewardship and enhance health system and environmental sustainability.

5. Strategic priorities

Four interrelated strategic priorities drive the Appropriate Use Strategy:

• Partnerships and Program Development
• Connect
• Strategy and Policy
• Evaluation and Reporting

These priorities link together and build on each other as essential parts of one whole. They will not achieve their desired outcomes as separate silos of activity. As the Appropriate Use Strategy unfolds, some initiatives will cross multiple priorities.

Partnerships and program development

Develop, enhance, and implement appropriate use initiatives with partners across Canada.

Great initiatives with the right supports can create significant impacts. CDA-AMC will share leading practices and support uptake of best evidence for appropriate use initiatives. We will also "spread and scale" promising initiatives so that they reach and benefit more people in Canada.

Action 1: Increase awareness and understanding of appropriate use

We will:

• share appropriate use materials and related tools among the public, patients, caregivers, and health care providers
• support those developing appropriate use resources with evidence and leading practices
• champion appropriate use curricula in clinical education programs, including continuing professional development.

Action 2: Implement a spread and scale program for promising practices

We will:

• identify projects and initiatives that have shown promise or success in improving appropriate use and could benefit more people by extending their reach
• increase the reach and impact of these projects and initiatives so they benefit more people
• collaborate with partners who lead similar initiatives.

Shared achievements to date

• CDA-AMC has identified the key pillars of our spread and scale program. When launched, this program will support promising initiatives to spread and scale so that they can benefit more people in Canada.
• Our partners are developing tools to raise awareness about polypharmacy (commonly defined as when a person is taking 5 or more medications at the same time) and support health care providers, patients, and caregivers in discussing it together.
• Our partners created a series of guides to increase understanding of appropriate use interventions among prescribers, decision-makers, and the public.

Connect

Link partners, enhance connections, and provide comprehensive information about appropriate use.

There is already much work happening to support appropriate use in Canada. Organizations working to improve appropriate use can achieve even greater impact through increased coordination and collaboration.

CDA-AMC will create opportunities to support shared learning and activities that complement each other, without duplicating each other, so that pan-Canadian partners working toward appropriate use will progress further and faster, together.

Action 3: Bring groups together for collaboration and learning

We will:

• convene partners at the pan-Canadian level and support and strengthen existing networks
• engage the provinces and territories to support their appropriate use priorities and their work with other partners
• participate in international appropriate use discussions.

Action 4: Connect people to existing appropriate use resources

We will:

• create an online resource hub to share partners' appropriate use resources with patients and caregivers, the public, health care providers, and others
• promote partners' appropriate use resources at conferences and events
• develop relationships and collaborate with equity-deserving groups to promote culturally safe and relevant appropriate use resources.

Action 5: Build relationships with First Nations, Inuit, and Métis partners to support their appropriate use interests

We will:

• listen to First Nations, Inuit, and Métis organizations and partners about their knowledge, interests, and priorities relating to appropriate use
• seek and implement guidance from First Nations, Inuit, and Métis partners on appropriate use projects
• where mutually desired, co-design projects with First Nations, Inuit, and Métis organizations and partners
• ensure an ongoing cycle of monitoring, review, or other evaluation frameworks, holding ourselves accountable to our actions and our relationships.

Shared achievements to date

• The Appropriate Use Coalition is a grassroots group of 11 health care organizations that are working together to improve the appropriate prescribing and use of medications. CDA-AMC provides secretariat support to the Coalition.
• The Appropriate Use Program Map shows appropriate use programs already established by partners across Canada. More website content is being added regularly.

Strategy and policy

Develop evidence-informed advice and recommendations for decision-makers about the adoption and implementation of appropriate use policies and strategic initiatives.

CDA-AMC will share knowledge with jurisdictional decision-makers to support them in making informed decisions about their appropriate use policies and programs. Based on what we learn through this work, we will also evolve the Appropriate Use Strategy.

Action 6: Provide jurisdictional decision-makers with timely evidence and thought leadership about appropriate use topics

We will:

• identify key appropriate use topics to support alignment with jurisdictional priorities
• provide decision-makers with information about lesser-known and/or important appropriate use topics.

Action 7: Deliver and evolve the pan-Canadian appropriate use strategy

We will:

• update the Appropriate Use Strategy to reflect new learning and needs.

Shared achievements to date

• Our partners gathered information about appropriate use topics in Canada to better understand the current landscape and identify areas of greatest need, opportunity, and impact. This information can be used to identify priority topics for future work.
• CDA-AMC began work on a program that will provide decision-makers with timely, relevant information on appropriate use topics that may be less well known.

Evaluation and reporting

Evaluate projects and clearly communicate their effectiveness.

What we measure, we manage. A cycle of evaluating, learning, and improvement will support improved efficiency, effectiveness, and quality for appropriate use initiatives.

As part of CDA-AMC's additional areas of work, our Data and Analytics team is collaborating with many partners, including the Canadian Institute for Health Information, to support an optimized pharmaceutical data and analytics ecosystem. We will work closely with this team on the following actions, and across all strategic priorities.

Action 8: Promote increased collection, access, and use of appropriate use metrics and data

We will:

• with pan-Canadian partner organizations, support people to navigate appropriate use data sources across Canada
• champion the development, measurement, and reporting of appropriate use indicators
• collaborate with partners to report on relevant data about appropriate use.

Action 9: Share lessons learned to drive continuous improvement

We will:

• embed evaluation into spread and scale projects and share the results for transparency and future learning
• identify and share effective practices for program implementation from our spread and scale program and other projects
• measure and report on progress made against delivering the pan-Canadian Appropriate Use Strategy.
  • CDA-AMC is accountable for monitoring and reporting on our work on this strategy through semiannual Progress and Performance Reports to Health Canada.

Shared achievements to date

• Our partners identified key appropriate use statistics and created an infographic to effectively communicate them.

6. Conclusion

When we build on a strong history, better futures are possible. Improving medication use and prescribing will support better health and more effective, safer care for people in Canada.

However, there is no one solution to advancing appropriate use. It is a challenge that requires the efforts of many partners and pan-Canadian commitment to a common vision.

A wide range of partners are already doing excellent work in appropriate use. This strategy is not the culmination of this work, but another chapter.

To achieve the best possible outcomes for people in Canada, we must all coordinate our efforts, strengthen our relationships, and share our learnings so that we can keep improving. As the Appropriate Use Strategy is implemented, CDA-AMC will continue to engage with interested parties, collaborate with our many partners working in appropriate use, and evolve the strategy to meet emerging health system needs.

The destination is clear. The potential for change is great. And with our path to improving medication appropriateness in Canada set out, our shared journey is well under way.

To learn more, visit Canada's Drug Agency.

Appendix 1

CDA-AMC Appropriate Use Advisory Committee Members

(as of June 30, 2025)

• Stephen Samis (co-chair)
• Dr. Jim Silvius (co-chair)
• Julia Bareham
• RxFiles
• Dr. Devin Harris
• Health Quality BC
• Dr. Wendy Levinson
• Choosing Wisely Canada
• Dr. Lisa McCarthy
• deprescribing.org
• Dr. Emily McDonald
• Canadian Medication Appropriateness and Deprescribing Network
• Connie Newman
• Manitoba Association of Senior Communities; member of the public
• Dr. Danielle Paes
• Canadian Pharmacists Association
• Dr. Andrea Patey
• IWK Health
• Dr. Danyaal Raza
• St. Michael's Hospital
• Julie Weir
• University of New Brunswick