Getting a prescription refilled or changed in Canada is set to become much easier, but the move to expand the powers of pharmacists is sparking controversy in the country's medical community.
New Brunswick will become one of the first provinces to move forward with legislation to significantly boost the ability of pharmacists to play a greater role in patient prescriptions.
Under proposed changes announced this week, pharmacists would not only provide refills without having to check with the doctor, but could also alter a patient's prescription or assign new medications for minor conditions.
Similar rules are already in place in Alberta and other provinces are in various stages of enhancing the role of pharmacists.
These moves will provide greater convenience to Canadians, who may not have immediate access to a doctor for a new prescription, allow pharmacists to better monitor a patient's response to treatment, and reduce the burden on overworked doctor's offices, said Janet Cooper, senior director of professional affairs at the Canadian Pharmacists Association.
"There's been a lot of movement in the last year," Ms. Cooper said. "It's about better medication management for Canadians."
But some medical associations and experts fear the expanded role could set a dangerous precedent. Many physicians agree it makes sense to let pharmacists refill prescriptions as long as a patient's health has not changed. However, they worry about the possibility that pharmacists will start to prescribe new medications on an increasing basis.
"If a pharmacist initiates treatment for a condition that's not diagnosed by a physician, then I think they're putting themselves and the patients at risk," said Brian Day, president of the Canadian Medical Association.
Provinces such as New Brunswick are moving to allow pharmacists to diagnose and prescribe treatment for minor conditions. Other provinces could follow suit, Ms. Cooper said. But that doesn't represent any threat to patients because pharmacists would be limited in what they could prescribe. They would only assign new medications for minor problems such as coughs, colds or skin rashes, she said.
"I can understand their [doctors'] concern, but pharmacists in general are quite cautious. I'm not concerned they're going to go out and do things outside their knowledge level," she said.
Despite those intentions, medical associations across Canada remain anxious that allowing pharmacists to prescribe new drugs to patients could be a risky move and may lead to a further expansion of those powers in the future, according to the British Columbia Medical Association.
"Whether it's the first step in a staircase to more privileges, that's a concern," said Bill Mackie, the association's president-elect. "Our hope is that it's just to facilitate, make life easier for patients and doctors."
The move toward expanding pharmacists' powers has rapidly taken shape in the past two years and many experts, including Dr. Mackie, say it's difficult to tell what the implications may be.
But some experts predict that serious conflict-of-interest concerns will arise once a majority of the country's pharmacists have greater power to prescribe drugs.
If pharmacists are able to choose which company's medication a patient will receive, the industry must adopt strict guidelines to prevent them from choosing a product that may represent a financial gain for the drug store, said Alan Cassels, a drug policy researcher at the University of Victoria.
"When you have a person who's doing both activities [prescribing and dispensing], it can lead to irrational prescribing and the profit motive getting in the way of good care," he said. "They're professional, but they are businessmen, let's not forget that."
But the Canadian Pharmacists Association said that argument has no merit and that pharmacists are not swayed by financial incentive. The association is not looking into guidelines or other policies to address potential conflict of interest because it's not an issue that will realistically affect the way pharmacists do their jobs, Ms. Cooper said.
"We've heard that raised a lot," she said. "The pharmacists are going to make evidence-based decisions. They're going to make sure they're prescribing the right drug for that patient."
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