B.C. nurses will soon be able to prescribe opioid-use disorder medication

Registered nurses and registered psychiatric nurses in British Columbia will soon be able to prescribe medication for opioid use disorder (OUD) in a move the province hopes will allow more people with addiction to seek help.

The B.C. College of Nurses and Midwives (BCCNM) announced in September that it had created a new designation of certified practice, to allow RNs and RPNs to diagnose and treat substance use disorder after completing training from the B.C. Centre on Substance Use.

B.C. is the first province in Canada to allow these new prescribing powers. Previously, prescribing OUD medication was the domain of doctors and nurse practitioners in the province, which has been gripped by a toxic drug crisis for a number of years. 

The president of the B.C. Nurses' Union says the news is a positive first step, but more needs to be done to get addictions treatment to people who need it, especially in non-urban areas of B.C.

"I think that expanding the scope of of registered nurses and psychiatric nurses with respect to opioid use disorder is a good move," Adriane Gear told CBC News.

"Long-term investments are still needed to build a comprehensive mental health and addictions care in B.C., but I think it's a good step in the right direction."

Some RNs and RPNs have been prescribing OUD medication after a September 2020 order from Public Health Officer Dr. Bonnie Henry, which came amid a significant spike in toxic drug deaths.

However, the new designation means there will be a more robust regulatory regime, and nurses will be allowed to continue prescribing medication after the order expires.

According to the province, 255 RNs and RPNs from all health authorities have enrolled in the training program as of Tuesday, and 144 have completed it.

Under the proposed scope of practice of the new designation, nurses will be able to prescribe drugs that are used for opioid agonist therapy, such as methadone and suboxone. Opioid agonist therapy is a form of treatment that involves taking medication that reduce withdrawals from opioid use.

The regulatory changes take effect Wednesday, and nurses will be required to have completed the training in order to prescribe medication starting Nov. 30.

Minister says move will help stabilize lives

Jennifer Whiteside, minister of mental health and addictions, said she was grateful to regulators and frontline workers who made the designation a reality.

"We know that having people who are struggling, particularly with opioid use disorder, having them in a position where they are able to to access quickly medication-assisted therapies is really important," she told CBC News. 

"The evidence is really strong about [medication] helping to stabilize their lives and really setting them up for success along their wellness journey."

Whiteside said that in August, there were 459 patients who had to fill prescriptions for drugs like methadone, slow release oral morphine and hydromorphone — and those prescriptions were written up by just 48 nurses.

"We know that if we scale that up and we have more nurses prescribing, we know that more people can access this life-changing treatment."

Gear says the province still needs to work on providing more treatment beds for people who need them, and that there is an acute lack of addictions services in rural communities.

Whiteside acknowledged the lack of prescribers for substance use medications in rural B.C., and said she hopes the new designation will help boost those numbers going forward.

There is no official count for the number of people with opioid use disorder in B.C., but a 2020 study estimated around 83,000 people had the disorder in 2017.

Advocates for drug users have said addictions treatment is one of the ways governments should respond to the toxic drug crisis, which has killed at least 12,929 people since a public health emergency was declared in B.C. in 2016.

However, they say the government should also focus on creating a safe supply of drugs.