Clarifying the College’s Position on Low-Dose Codeine
The College would like to provide guidance regarding naturopathic physicians’ interactions with patients in relation to low-dose, non-prescription codeine products available in pharmacies.
As registrants are aware, naturopathic physicians are not authorized to prescribe substances listed in any schedule of the Controlled Drugs and Substances Act (CDSA). While codeine is included under the CDSA, certain low-dose formulations remain available without a prescription directly from a pharmacist.
This article is intended to clarify how naturopathic physicians can navigate these situations in a way that respects scope of practice boundaries while continuing to support person-centered care.
Recommending Low-Dose Codeine
Under the federal regulatory framework, naturopathic physicians are not granted authority in relation to low-dose codeine products. For that reason, it is not appropriate for naturopathic physicians to recommend that a patient obtain low-dose codeine from a pharmacy.
This distinction is important in maintaining clarity about scope of practice and ensuring that regulated health care practitioners operate within their authorized roles.
Referrals and Collaborative Care
At the same time, the College recognizes the important difference between:
- Recommending a specific drug, and
- Referring a patient to another qualified health care practitioner for assessment and advice.
If a naturopathic physician believes that a treatment option outside their scope of practice — such as low-dose codeine — may be relevant to a patient’s clinical circumstances, the naturopathic physician may:
- Clearly explain their scope of practice and professional limitations; and
- Suggest that the patient consult an appropriate health care practitioner (for example, a pharmacist) who is authorized to assess suitability, determine appropriateness, and provide care in accordance with applicable laws and standards.
This approach supports collaborative, person-centered care while maintaining professional integrity and regulatory compliance.
Supporting Patients While Respecting Scope
Maintaining clear scope boundaries protects both patients and practitioners. At the same time, transparent communication and appropriate referrals ensure that patients are able to access the care they need from the health care practitioners authorized to provide it.
The College encourages registrants to approach these situations with clarity, professionalism, and a collaborative mindset — reinforcing the shared goal of safe and effective patient care.
