As of May 1, 2024, Nova Scotia Pharmacists have been able to diagnose and treat Early/Acute Lyme disease. The following is from the Nova Scotia College of Pharmacists website under “Notices”:

“Effective May 1, 2024, pharmacists will be authorized to assess and prescribe for the treatment of early Lyme disease. For clarity, this is in addition to the existing authority to prescribe chemoprophylaxis for the prevention of Lyme disease. Of note:

• The standards set out:
• • the competencies required to provide this care;
  • patient eligibility requirements for treatment of early Lyme disease by a pharmacist; and
  • that the treatment protocol must be consistent with the Nova Scotia Infectious Disease Expert Group Guidance.
• PANS will host an education session on assessing and prescribing for early Lyme disease with Drs. Tasha Ramsey and Emily Black at 7:00 PM on May 7, 2024. For more information and to register, please click on the appropriate link below:
• • PANS Member (free) 
  • PANS Non-member 
• PANS has been working with the Department of Health and Wellness on funding for this prescribing, with an expected announcement in May.”
  

As it is now June 24th and I have yet to see an announcement, I believe it is due to the fact that funding has not yet been finalized for all pharmacies. I have heard via two pharmacists now that some pharmacies are free for this service and some charge. The fee is fairly nominal but is apparently resulting in an announcement not yet being made.

I am given to understand that a person needs to have an erythema migrans (EM) rash for diagnosis so this will continue to eliminate a certain percentage of the population that do not get, or see, a rash, from receiving a prompt diagnosis. As well, I hope that pharmacists have been adequately trained on what constitutes an EM Lyme rash. Some helpful information – https://www.aad.org/public/diseases/a-z/lyme-disease-signs; https://www.cdc.gov/lyme/signs-symptoms/lyme-disease-rashes.html; and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9687974/.

Pharmacists are also required to utilize the NS Lyme Guidelines as prepared by the NS Infectious Disease Expert Group – https://novascotia.ca/dhw/cdpc/documents/statement-management-ld-hga-b-pvi.pdf. Unfortunately, these guidelines recommend following the IDSA Lyme Guidelines – https://www.idsociety.org/practice-guideline/lyme-disease/ – even though the IDSA Lyme Guidelines include a disclaimer under the Notes section that they are guidelines only, are voluntary, and do not supplant physician judgement. The fact that there are at least three other Lyme guidelines available for use is not mentioned.

The three other Lyme guidelines are:

• Centre for Effective Practice (Canadian) – https://cep.health/clinical-products/early-lyme-disease/;
• ILADS Guidelines – https://www.ilads.org/patient-care/ilads-treatment-guidelines/; and
• NICE Guidelines – https://www.nice.org.uk/guidance/ng95.

The other issue, of significant note, is that ticks can transmit other things along with, or instead of, Lyme. Hopefully people receiving a diagnosis and treatment of Lyme will be adequately educated on the fact that they should keep note of any new symptoms that might occur and to ensure follow-up if they do have some.