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Opioid agonist treatment

It is now within the scope of nurse practitioners to prescribe opioid agonist treatment (OAT) for opioid use disorder.

As of Feb. 14, 2018, prescribing opioid agonist treatment (OAT) for opioid use disorder is within the scope of nurse practitioners (NPs).

Before prescribing opioid agonist treatment for opioid use disorder, NPs must complete the requirements for:

  • Controlled Drugs and Substances Prescribing as set out in Part 2, Section C of the Scope of Practice for Nurse Practitioners
  • Opioid Agonist Treatment Prescribing for Opioid Use Disorder as set out in Part 2, Section D, of the Scope of Practice for Nurse Practitioners

The standards, limits and conditions for OAT set out the requirements for both induction and continuation/maintenance prescribing of opioid agonist treatment for opioid use disorder. These standards, limits and conditions do not apply to prescribing opioid agonists for pain and other symptoms.

Standards, limits and conditions

Standards

  1. Nurse practitioners prescribing opioid agonist treatment meet the standards, limits and conditions set out in C. Prescribing Drugs in the Scope of Practice for Nurse Practitioners.
  2. Nurse practitioners prescribing opioid agonist treatment apply the clinical practice guidelines for the treatment of opioid use disorderestablished by the BC Centre on Substance Use.
  3. Nurse practitioners prescribing opioid agonist treatment apply knowledge about:

    a.substance use disorders including opioid use disorder,
    b. treatment strategies for opioid use disorder (e.g. opioid agonist treatment, psychosocial treatment interventions), and
    c. harm reduction strategies for opioid use disorder.

  4. When prescribing opioid agonist treatment, nurse practitioners:

    a. make or confirm a diagnosis of opioid use disorder using the DSM-5TM diagnostic criteria,
    b. review the client’s medication profile and history through PharmaNet and other sources,
    c. assess for other substance use disorders and/or concurrent use of substances (e.g. alcohol, benzodiazepines, other sedative-hypnotics), and
    d. develop a treatment plan that takes into account any risks identified during the client’s assessment.

  5. Nurse practitioners prescribe opioid agonist treatment in a manner that promotes client and public safety (e.g. prescribe as daily witnessed ingestion until the client has sufficient clinical stability and is able to safely store take-home (carry) doses).

Limits and Conditions

  1. Nurse practitioners who only prescribe buprenorphine-naloxone on a continuation basis for the treatment of opioid use disorder must have completed:
    a. additional education1, and
    b. a preceptorship, of a minimum of two half-days length, under the guidance of a practitioner who has expertise prescribing opioid agonist treatment and treating clients with opioid use disorder.
  2. Nurse practitioners who prescribe opioid agonist treatment for opioid use disorder (other than continuation prescribing of buprenorphine-naloxone) must have completed:

    a. additional education offered by the British Columbia Centre on Substance Use2, and
    b. a preceptorship that meets the requirements established by the British Columbia Centre on Substance Use.

  3. Nurse practitioners obtain an exemption from Health Canada under section 56 of the Controlled Drugs and Substances Act before prescribing methadone.

Footnotes

  1. Additional education is structured education (e.g. workshop, course, program of study) designed so that nurse practitioners can attain the competencies required to carry out a specific activity as part of nurse practitioner practice. Additional education builds on the entry-level competencies of nurse practitioners, identifies the competencies expected of learners on completion of the education, includes both theory and application to practice, and includes an objective, external evaluation of learners’ competencies on completion of the education. The terms does not refer to a course or program approved by CRNBC for CRNBC certified practice.
  2. Or equivalent as determined by the BC Centre on Substance Use.

BC Centre on Substance Use

Online education and preceptorship information as well as clinical care guidance for OAT can be found on the BCCSU website. Please contact them if you have questions about the education and preceptorship requirements for OAT prescribers.  

Prescribing methadone for the treatment of opioid use disorder

Opioid agonist drugs used for the treatment of opioid use disorder are controlled drugs under the Controlled Drugs and Substances Act. The Narcotic Control Regulations require methadone prescribers to hold an exemption from Health Canada under section 56 of the Controlled Drugs and Substances Act.

Note: methadone maintenance pads that are initially available will have College of Physicians and Surgeons of BC ID numbers on them.

CRNBC will apply for this exemption on your behalf when you submit you first order for methadone prescription pads.

Note that it will take a number of weeks for the section 56 exemption to be granted, and another three to four weeks for the printer to process the order and send out the pads. You may order up to three pads at a time.

Methadone for analgesia remains out of scope for nurse practitioners.

Updated process for ordering prescription pads

Ministry of Health requirements for preprinted pads (Both CDS and Methadone):

Prescription pads will be delivered by Xpresspost. The ordering NP is the only person who can sign for them.

At the time of delivery:

  • Identification matching the name on the personalised pads must be provided
  • The individual whose name is printed on the pads must sign for the delivery

Canada Post will attempt delivery twice. If delivery is unsuccessful, the order will be forwarded to CRNBC. CRNBC will then contact the NP to organize delivery.

Note: As the pads will now be delivered directly from the printer, processing and shipping time for your order will increase to three to four weeks. When planning your orders, factor in this added time. You may now order up to three pads at a time.

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