8.2 Controlled Substances: The Controlled Substances Regulations, Narcotics, Controlled Drugs, Targeted Substances & Cannabis
Key Takeaways
On October 1, 2026, the Controlled Substances Regulations (SOR/2025-242) replaced the Narcotic Control Regulations, the Benzodiazepines and Other Targeted Substances Regulations, and Parts G and J of the Food and Drug Regulations.
Under the Controlled Substances Regulations, a practitioner may prescribe any narcotic, controlled drug or targeted substance verbally, and a pharmacist or pharmacy technician may receive and record it where provincial rules allow.
Refills may now be authorized for narcotics, controlled drugs and targeted substances, and a pharmacist may extend a controlled-substance prescription up to two years after the pharmacy received it.
A pharmacist or pharmacy technician may transfer a controlled-substance prescription to another pharmacist or technician within two years after it was received, and may destroy controlled substances with a qualified witness.
Only a pharmacist may sell or provide a controlled substance to the patient, and controlled-substance records must be kept at least two years (longer where provinces require).
Controlled Substances: The Controlled Substances Regulations, Narcotics, Controlled Drugs, Targeted Substances & Cannabis
Exam Tip: Controlled-substance law is high-yield and it changed recently. On October 1, 2026, Health Canada's Controlled Substances Regulations (CSR, SOR/2025-242) came into force. They consolidated the Narcotic Control Regulations (NCR), the Benzodiazepines and Other Targeted Substances Regulations (BOTSR), and Parts G and J of the Food and Drug Regulations. They also made permanent the COVID-era subsection 56(1) class exemption (March 2020 to September 30, 2026) that let pharmacists extend and transfer controlled-substance prescriptions and accept verbal prescriptions. Learn the current CSR rules first, then the legacy rules in the comparison table, because older textbooks and question banks still use them. Provinces may be stricter than the federal rules, and the stricter rule applies.
1. What Counts as a Controlled Substance
The Controlled Drugs and Substances Act (CDSA) sets the criminal schedules. The CSR lists the substances pharmacies handle in four schedules:
| CSR Schedule | Category | Label Symbol | Examples |
|---|---|---|---|
| Schedule 1 | Narcotics | N | Codeine, morphine, hydromorphone, oxycodone, fentanyl, methadone, buprenorphine, tramadol, meperidine, ketamine, nabilone |
| Schedule 2 | Controlled drugs (Parts 1, 2, 3) | C | Part 1: amphetamines, lisdexamfetamine, methylphenidate, pentobarbital, secobarbital. Part 2: barbiturates (phenobarbital, butalbital), phentermine, butorphanol, nalbuphine. Part 3: anabolic steroids (testosterone) |
| Schedule 3 | Targeted substances | T/C | Benzodiazepines (alprazolam, clobazam, clonazepam, diazepam, lorazepam, midazolam, oxazepam, triazolam) and zolpidem |
| Schedule 4 | Restricted drugs | none | Substances with no approved medical use (not dispensed in pharmacies) |
Watch the traps:
- Zopiclone is not a controlled substance in Canada. It is a prescription (Pr) drug only, unlike zolpidem, which is a targeted substance.
- Tramadol became a narcotic in 2024, and nabilone is a narcotic (N).
- Products such as Tylenol No. 2, No. 3 and No. 4 are narcotics because they contain codeine.
2. Receiving Prescriptions
| Topic | CSR Rule (from October 1, 2026) |
|---|---|
| Written prescriptions | Signed and dated by a practitioner. Electronic prescriptions are acceptable where the digital signature can be authenticated. Verify the prescriber's signature if it is not known to you (s. 103). |
| Verbal prescriptions | A practitioner may prescribe any narcotic, controlled drug or targeted substance verbally (s. 127). The verbal prescription must come from the practitioner, not an office assistant. |
| Who may receive them | A pharmacist or pharmacy technician may receive written or verbal prescriptions and must record them (ss. 116 to 117), where provincial rules also allow it. British Columbia and Ontario have confirmed technician authority. |
| Verbal record contents (s. 117) | Receiver's name; practitioner's name and practice address; date received; drug name, form and quantity, or for a finished product the brand, strength, number of units and DIN; directions; number of refills and interval if specified. |
| Who releases to the patient | Only a pharmacist may sell or provide the controlled substance to the patient (s. 98), because patient consultation is pharmacist scope. |
3. Refills, Part-Fills, Extensions and Adaptations
- Refills: A prescriber may authorize refills for narcotics, controlled drugs and targeted substances. The pharmacy records the number of refills and any interval (ss. 113, 117) and records each refill (s. 118). Intervals are optional; if one is given, it must pass before the next refill.
- Part-fills, adaptations and de-prescribing: A pharmacist may part-fill, adjust the formulation, dose or regimen, or de-prescribe, as long as the total quantity dispensed does not exceed the total the practitioner authorized and provincial scope allows it.
- Extensions (s. 101): A pharmacist may extend a controlled-substance prescription if the new expiry date is no later than two years after the day the pharmacy received the prescription. Provinces add limits. For example, British Columbia allows extension only for continuity of care, for no more than the originally prescribed amount or 30 days, whichever is greater.
- Therapeutic substitution (s. 100): Allowed federally only where the province authorizes the pharmacist to substitute. British Columbia and Ontario do not allow therapeutic substitution of controlled substances.
4. Transfers (s. 102)
A pharmacist or pharmacy technician may transfer a controlled-substance prescription to another pharmacist or pharmacy technician if:
- the transfer happens within two years after the day the prescription was received; and
- the sender provides the written prescription, or a copy of the record of the verbal prescription.
Both sides record the details (s. 119): each professional's name and practice address, the prescription number, the transfer date, the date of the last refill, the refills remaining and any interval, and any extension. The CSR sets no federal limit on the number of transfers. Check provincial rules for any added limit.
5. Low-Dose Codeine Products (s. 98(2))
A pharmacist may sell without a prescription a product containing no more than 8 mg of codeine phosphate per solid unit, or 20 mg per 30 mL of liquid, if it also contains two additional non-narcotic medicinal ingredients (at least the minimum single dose of one, or half of each) or three (at least the minimum single dose of one, or one-third of each). Example: Tylenol No. 1 (acetaminophen 300 mg, caffeine 15 mg, codeine phosphate 8 mg).
- The pharmacist must believe the product will be used only for recognized medical purposes.
- The label must carry the caution: "This product contains codeine and should not be administered to children except on the advice of a physician, dentist or nurse practitioner."
- NAPRA schedules these products as Schedule II (pharmacist intervention; kept behind the counter), and some provinces add record-keeping or monitoring requirements.
6. Security, Records, Loss or Theft, and Destruction
- Security (ss. 105, 108): Store controlled substances in a secure location that only authorized staff can access. Pharmacists and technicians must take all reasonable measures to secure the controlled substances in their possession.
- Receiving stock (s. 111): A pharmacist orders controlled substances. A pharmacist or pharmacy technician may receive them and record the supplier, date, product, DIN and quantity. Provinces may add rules; British Columbia, for example, requires a pharmacist to sign purchase and receipt records.
- Record retention (s. 123): Keep records, prescriptions and declarations for at least two years, in date and number order, auditable and legible. Provinces often require longer; Ontario, for example, keeps prescription records for at least 10 years.
- Loss or theft (s. 109): A technician tells the pharmacist immediately. The pharmacist sends Health Canada a written report within 10 days after becoming aware. Thefts are also reported to the police.
- Destruction (s. 110): On site, destruction may be done only by a pharmacist or pharmacy technician, witnessed by a pharmacist, technician, intern, practitioner or other health professional. The method must meet environmental laws, and the two sign a joint declaration. No prior Health Canada approval is needed. Alternatively, send the stock to a licensed dealer that specializes in destruction, in a sealed, tamper-evident, marked container.
- Delivery (ss. 106 to 107): Pharmacists and technicians may deliver or send controlled substances using a trackable method with reasonable security.
- Pharmacy-to-pharmacy supply (s. 93): Besides emergency sales, a pharmacist may now supply another pharmacist to fill a prescription received at the other pharmacy, which allows central-fill models.
7. Legacy Rules You Will Still See (before October 1, 2026)
| Topic | Legacy Rule (NCR / FDR Part G / BOTSR) | CSR Rule (from October 1, 2026) |
|---|---|---|
| Verbal prescriptions | Only for "verbal prescription narcotics" (a narcotic with 2 or more non-narcotic ingredients in therapeutic doses, not parenteral, and not containing heroin, hydrocodone, methadone, oxycodone or pentazocine), for Part G drugs, and for targeted substances, and received only by a pharmacist. Tylenol No. 2 and No. 3 qualified; Tylenol No. 4 (acetaminophen 300 mg + codeine 60 mg, no caffeine) did not. | Any controlled substance, from the practitioner, received by a pharmacist or pharmacy technician |
| Narcotic refills | Not permitted: a pharmacist could not dispense beyond the prescribed quantity (NCR s. 37). Part-fills were used instead. | Refills may be authorized |
| Part G refills | Only if the prescriber specified the number and the dates or intervals, in writing for Part I drugs | Refills may be authorized; intervals optional |
| Targeted substance refills | Not more than one year after the prescription was issued (BOTSR s. 52) | Refills may be authorized; extension up to 2 years after receipt |
| Transfers | Narcotics and Part G drugs could not be transferred; a targeted substance could be transferred once, pharmacist to pharmacist (BOTSR s. 54) | Pharmacist or technician, within 2 years of receipt, no federal limit on the number |
| Destruction | Needed Health Canada authorization or a class exemption; BOTSR required a pharmacist or practitioner as witness | Pharmacist or technician destroys, with a qualified witness, no prior approval |
| Loss or theft | Report within 10 days (NCR s. 42; FDR G.03.013; BOTSR s. 72) | Unchanged: written report within 10 days (s. 109) |
| Record retention | At least 2 years | At least 2 years |
8. The Cannabis Act and Cannabinoid Medicines
- Non-medical cannabis is sold through provincially authorized retailers, not through pharmacies.
- Medical cannabis: The patient gets a medical document from a health care practitioner (a physician or nurse practitioner, where the province allows) and registers with a federally licensed seller, which ships to the patient. Community pharmacies do not dispense dried cannabis.
- Cannabinoid drug products with DINs are dispensed by prescription: nabilone (Cesamet and generics) is a narcotic (N), and nabiximols (Sativex, a THC/CBD oral spray) is a prescription drug containing cannabis.
On October 20, 2026, a family physician personally telephones a pharmacy and speaks with a registered pharmacy technician. The physician prescribes hydromorphone 2 mg tablets, 1 tablet every 4 hours as needed, 30 tablets. The province's rules allow technicians to receive verbal controlled-substance prescriptions. What should the technician do?
Refuse the call, because hydromorphone is a narcotic that can never be prescribed verbally in Canada.
Accept it, then complete the technical check and hand the hydromorphone to the patient without involving a pharmacist.
Receive the verbal prescription and record the details the Controlled Substances Regulations require, then route it to the pharmacist for clinical review and release to the patient.
Accept it only if the physician's office also faxes a signed copy within 72 hours.
In November 2026, a patient asks a pharmacy to transfer a lorazepam 1 mg prescription with refills remaining. The prescription was already transferred once in 2025 and was received by the current pharmacy 10 months ago. The province has no stricter rule. Can a registered pharmacy technician at the current pharmacy transfer it?
Yes. The Controlled Substances Regulations let a pharmacist or pharmacy technician transfer a controlled-substance prescription within two years after it was received, with no federal limit on the number of transfers.
No. A targeted substance may be transferred only once in its lifetime, and this one has already been transferred.
No. Controlled-substance prescriptions can be transferred only by pharmacists, never by technicians.
Yes, but only after the prescriber confirms the transfer in writing.
A community pharmacy has expired oxycodone and lorazepam in its unserviceable-stock bin. In December 2026, a registered pharmacy technician is asked to arrange destruction on site. Which approach meets the Controlled Substances Regulations?
Request prior written authorization from Health Canada, then have only a pharmacist destroy the stock.
Have the technician denature the stock using an environmentally compliant method, with a pharmacist, another technician, an intern, a practitioner or another health professional as witness, and have both sign a joint declaration.
Flush the tablets down the sink with a witness present and note the quantities in the narcotic register.
Place the stock in the pharmacy's patient medication-return bin so it is mixed with post-consumer returns.
Sections you finish are checked off in the contents.