Controlled Substances Policy

Opioids • Benzodiazepines • Stimulants • Sedative-Hypnotics • Other Controlled Medications

Villa Nova Medical Clinic follows strict standards for prescribing controlled substances to ensure patient safety, prevent medication-related harm, and comply with CPSNL, CMPA, and Canadian regulatory guidelines.


*This policy applies to all patients receiving care at our clinic.*

General Principles

Controlled medications may be prescribed only when medically necessary, and when the potential benefits outweigh the risks.
Prescribing decisions are based on:

  • Clinical assessment and evidence-based guidelines

  • Review of the patient’s medical history and current medications

  • Risk–benefit evaluation and monitoring requirements

  • Physician judgment and CPSNL prescribing standards

Not all patients will be prescribed controlled substances, and prescriptions may be reduced, adjusted, or discontinued when appropriate.

Prescribing Responsibility

To ensure safe prescribing and continuity of care, controlled substances may only be prescribed or renewed by the patient’s primary physician at Villa Nova Medical Clinic.
Other clinic physicians cannot renew or manage controlled substances for patients who are not paneled under their care.

This includes, but is not limited to:

  • Opioids

  • Benzodiazepines

  • Stimulants

  • Sedative-hypnotics

  • Any medication designated as a controlled substance under federal or provincial regulation

If the primary provider is unavailable, patients may be offered:

  • A short interim supply at the provider’s discretion, OR

  • Referral to an appropriate care setting

In-Person Assessment Required

For safety reasons:

  • All initial prescriptions for opioids, benzodiazepines, stimulants, and similar medications require an in-person visit.

  • Refills also require an appointment (in-person or virtual, depending on clinical appropriateness — at the physician’s discretion).

  • Controlled substances will not be renewed through:

    • Phone calls to reception

    • Voicemail requests

    • Email messages

    • Walk-ins

Patients are responsible for booking appointments ahead of time to avoid interruptions in medication.

No Early Refills, Lost Prescriptions, or Stolen Medication Replacements

To ensure safe prescribing:

  • Early refills are not provided, regardless of the reason.

  • Lost, stolen, forgotten, damaged, or misplaced medications cannot be replaced.

  • Pharmacies may provide an emergency interim supply at their discretion, but the clinic does not authorize early replacements.

Use of the Prescription Monitoring Program (NLPDP / Pharmacy Network)

Physicians routinely review medication history through Newfoundland & Labrador’s Prescription Monitoring tools, including:

  • Pharmacy Network dispensing records

  • Previous controlled-substance prescriptions

  • Potential duplication or interactions

This is required for safe care and helps prevent medication-related harm.

Treatment Agreements & Monitoring Requirements

Depending on the medication and clinical context, patients may be required to:

  • Sign a Controlled Substances Treatment Agreement

  • Provide urine drug screens at random intervals

  • Use one designated pharmacy

  • Attend scheduled follow-up appointments

  • Participate in reassessment if dosage changes are needed

Failure to comply may affect ongoing prescribing.

Transitioning Care From Other Providers

When a patient is new to the clinic or new to a provider:

  • Controlled-substance prescriptions are not automatically continued.

  • A complete assessment is required before any prescribing decisions are made.

  • Previous prescribing patterns may be adjusted to align with current safety standards.

If a patient is transferring from another provider, they may be asked to provide:

  • Prior medical records

  • Pharmacy dispensing summaries

  • Relevant specialist notes

Virtual Care Limitations

For safety and regulatory reasons:

  • Some controlled-substance renewals cannot be completed virtually.

  • Physicians determine on a case-by-case basis whether virtual assessment is clinically appropriate.

  • Patients may be required to attend the clinic for monitoring (e.g., blood pressure checks, symptom review, urine drug screens).

Shared Care & Specialist Involvement

In some cases, patients may be referred to:

  • Psychiatry

  • Chronic pain clinics

  • Addiction medicine

  • Neurology or other specialties

Specialists may guide treatment, but the final prescribing decision remains with the clinic physician.

Medication Safety & Patient Responsibilities

Patients must:

  • Store medications securely

  • Not share medications with anyone

  • Not alter dosing without physician approval

  • Disclose all medications obtained from other providers

  • Inform the clinic of any adverse effects or concerns

Situations Where Prescribing May Be Discontinued

Prescribing may be paused, tapered, or discontinued in cases such as:

  • Evidence of unsafe use or diversion

  • Repeated missed appointments

  • Not completing required monitoring (e.g., urine drug screens)

  • Obtaining controlled substances from multiple providers without disclosure

  • Abusive behaviour toward staff or violations of clinic policies

  • Clinical judgment that risks outweigh benefits

If prescribing is stopped, the physician will offer safe tapering guidance and/or referral to appropriate supports.

Emergencies & After-Hours Care

The clinic does not provide controlled-substance prescriptions:

  • After hours

  • Through voicemail

  • Through email

  • Through walk-in requests

Emergency rooms generally do not replace controlled medications; they treat urgent issues only.

Patient Acknowledgment

By receiving care at Villa Nova Medical Clinic, patients acknowledge and agree to follow:

  • This Controlled Substances Policy

  • Monitoring and assessment requirements

  • Safe use and storage guidelines

  • Appointment and refill procedures

Failure to follow this policy may result in changes to prescribing, or in rare cases, termination of the physician–patient relationship in accordance with CPSNL/CMPA guidelines.