Quebec pharmacists may soon have more powers: What are they?

Last month, the Quebec government tabled Bill 67, saying it would again give pharmacists more power to help people with certain health concerns.

"I think that everybody wins by not having to go to a doctor's office or an emergency room to have a prescription for something that you know that you have," said Treasury Board President Sonia LeBel at the time.

The Coalition Avenir Québec (CAQ) says the goal is for pharmacies to be a one-stop shop for people with minor health problems or common illnesses.

"Bill 67 aims to revise pharmacists' scope of practice and the activities reserved for them, including prescribing drugs and extending prescriptions," notes Marie-Claude Lacasse, a communications coordinator with the Quebec Health Ministry.

What can you see a pharmacist for?

Some of the things pharmacists can already do are modify a prescription, substitute one drug for another or request tests to assess the impact of a treatment.

Pharmacists can also prescribe medication for certain health conditions or offer preventative treatments.

Right now, they can also give a patient a drug if it has already been prescribed in the past two to five years by a doctor.

This is one of the things that will change under Bill 67.

"This new bill will eliminate administrative rules to make room for professional judgment of pharmacists," said Jean-François Desgagné, president of Quebec's Order of Pharmacists. "They will be able to go to the pharmacy to seek primary care for common conditions such as dermatitis, seasonal allergies and minor infections."

Desgagné points out that it was important for the Order that the red tape surrounding pharmacists be eliminated.

"If there are two children who come in at the pharmacy and they have dermatitis eczema, and it's clear that it's eczema, but one has a prior diagnosis, and the other does not, there's an inequity there," he said. "It's the same cortisone cream [that] I can prescribe. So, one I can, and one I cannot, so this new bill will simplify lots of things."

He notes that in 2023, pharmacists provided 1.7 million consultations across the province, leading to 5.5 million prescriptions for Quebecers.

The current rules

Pharmacists can provide a prescription within two years of a doctor's prescription for:

• oral candidiasis (oral thrush)
• primary dysmenorrhea (menstrual cramps)
• hemorrhoids

Pharmacists can provide a prescription within five years of a doctor's prescription for:

• mild acne without nodule (tissue growth) or pustule (pimple or blister)
• mouth ulcers
• cutaneous candidiasis (fungal skin infection)
• oral candidiasis (oral thrush) due to corticosteroid inhalers
• allergic conjunctivitis (pink eye)
• atopic dermatitis/eczema requiring moderate corticosteroids
• diaper rash
• herpes labialis (cold sores)
• urinary tract infection (UTI) in women (no more than once in six months or twice in 12 months)
• allergic rhinitis (hay fever)
• yeast vaginitis (yeast infection)

In addition, pharmacists can treat certain health problems preventatively or without a doctor's diagnosis:

• stop smoking
• hormonal contraception (up to six months)
• emergency oral contraception
• nausea and vomiting
• perinatal vitamin supplementation
• emergency situations requiring beta-adrenergic agonists (such as asthma)
• preventative antibiotic for tick bites (Lyme disease)
• preventative antibiotic for patients with mechanical valves
• preventative antiviral for people at risk of developing complications from influenza or COVID-19
• cytoprotective prophylaxis for at-risk patients (such as for stomach ulcers)
• altitude sickness (not dexamethasone or sildenafil)
• malaria prevention
• prevention after exposure to HIV
• mild topical corticosteroid therapy for allergic contact dermatitis
• traveller's diarrhea
• dyspepsia (indigestion) or gastro-oesophageal reflux, under certain conditions
• gonorrhea and chlamydia as covered by the Quebec Health Ministry's program for the accelerated treatment of partners

Pharmacists can also prescribe antiviral medication for herpes zoster (shingles), influenza and COVID-19, offer over-the-counter medications for physical and mental self-care and administer vaccines and other immunizing products, such as for travel.

In addition, pharmacists are qualified to take samples (such as inserting an instrument into the pharynx to perform a rapid test for Group A streptococcal) and demonstrate appropriate use of a medication, such as epinephrine (EpiPen) or salbutamol (Ventolin).