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Edited by Mirabella Chan
If you are anything like me before I started pharmacy school, you may be wondering why certain medications are only available with a prescription, or by first talking to a pharmacist, or even why medications are organized the way they are in the pharmacy. This article aims to provide an overview of where certain medications can be found in a pharmacy and more importantly, why they are organized the way they are.
Drug Schedules
In Canada, medications are grouped into one of four categories (or schedules), broken down as follows:
Schedule I
This category includes all prescription medications. These medications are determined to be safe for use under the supervision of a prescriber and can only be dispensed after a diagnosis has been made or confirmed.
Note: Depending on the medical condition and province, a pharmacist may be able to prescribe some of these medications. The list of conditions for which a pharmacist can prescribe varies by province. In Nova Scotia, for example, pharmacists can prescribe for ~35 different conditions including acne, eczema, and birth control. For a list of prescriptive authority by province, click here.
Schedule II
These medications are usually found behind the counter in a pharmacy but do not require a prescription or diagnosis by a physician. They do, however, require the pharmacist to assess the patient first. This allows pharmacists to determine which medication (if any) is best for the patient, or if they should see a physician for further assessment.
Examples of drugs in this category include certain vaccines, insulin, iron supplements, naloxone, epinephrine, pseudoephedrine, and Tylenol #1.
Schedule III
If you’ve ever been in the pharmacy section of a grocery store when the pharmacy is closed, you may have noticed that some medications are inaccessible, typically locked in a “box” in the aisles. These are drugs that do not require a prescription or an assessment by a pharmacist but are still found in an area where a pharmacy staff member can supervise patients selecting the medication. In other words, the patient can select these medications themselves, but a pharmacist must always be present in order for these products to be accessible. Some pharmacists may even choose to keep certain Schedule III medications behind the counter to ensure they speak with the patient before allowing the purchase. This is because some of these drugs can be harmful to certain groups of people, especially children.
Examples of drugs in this category include heartburn medications (e.g., Nexium and Zantac), Flonase, Nasonex, 0.5-1% hydrocortisone, and Canesten.
Unscheduled
This category includes anything not mentioned above. While commonly seen in pharmacies, these medications can also be sold outside of pharmacies, such as in gas stations, grocery stores, or any other retail outlet. Patients are able to select these medications themselves, as these drugs are relatively safe for use as long as the instructions on the packaging are followed.
Examples of drugs in this category include acetaminophen, ibuprofen, benzoyl peroxide, and allergy medications such as cetirizine (Reactine).
These drug categorizations are determined at the national level by the National Association of Pharmacy Regulatory Authorities (NAPRA). This means that all pharmacies in Canada (with the exception of Quebec) follow the same rules. For example, Nexium will be kept in a lockable section of the pharmacy regardless of where you are in the country. Quebec maintains its own separate drug schedules and as of now, has no plans to switch over.
Bottom Line
If you ever have any questions about where to find a certain medication, just ask your pharmacist! Although drug schedules are much more complicated than this, I do hope that this helps shed some light on what goes on behind the scenes and helps give you an idea of where the medications you are looking for can be found.
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References
Assessing and Prescribing for Minor Ailments. Pharmacy Association of Nova Scotia (PANS). Accessed 24 April 2021. https://pans.ns.ca/public/pharmacy-services/assessing-prescribing-minor-ailments
Drug Scheduling in Canada. National Association of Pharmacy Regulatory Authorities (NAPRA). Accessed 24 April 2021. https://napra.ca/drug-scheduling-canada-general-overview
Pharmacists’ Expanded Scope of Practice. Canadian Pharmacists Association. Accessed 30 April 2021. https://www.pharmacists.ca/pharmacy-in-canada/scope-of-practice-canada/
