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Registered nurses will soon start prescribing medications to treat the use of opioids.

RNs to begin prescribing addiction treatment medications

Published 10:19 PST, Mon February 8, 2021

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The first cohort of registered nurses (RNs) is on track to begin prescribing medications for treatment of opioid use disorder, as part of B.C.'s overdose response plan.

Thirty RNs and registered psychiatric nurses (RPNs) will complete their training this month to prescribe buprenorphine/naloxone (commonly known as Suboxone), which is a first-line opioid agonist treatment (OAT) medication. This is the first step in a phased approach to expand RNs and RPNs' scope of practice to include prescribing addiction treatment medications.

"We are coming up on five years since British Columbia declared overdose a public health emergency, and more than 6,000 people have died because of toxic street drugs since that time," said Provincial Health Officer Dr. Bonnie Henry. "The COVID-19 pandemic has put people who use drugs at much higher risk for overdose. This crisis isn't unique to our province—it's a national issue—but B.C. is breaking ground when it comes to our response.”

This change follows Henry's public health order to authorize RNs and RPNs to prescribe some controlled drugs and substances. RNs and RPNs now join family physicians, psychiatrists and nurse practitioners who are already prescribing OAT medications, such as Suboxone. Training will continue with additional cohorts and will advance to include other medications, such as slow-release oral morphine and methadone, to meet the needs of more patients.

"Too many people in our province are grieving the loss of someone they love, and far too many people remain at risk of overdose. Highly toxic street drugs are rampant, and we must separate people from these dangerous, unpredictable drugs," said Mental Health and Addictions Minister Sheila Malcolmson. "Expanding access to addiction treatment medications is essential to getting a handle on this crisis. We are building our capacity to do this by balancing urgent action with careful implementation to ensure patient and practitioner safety every step of the way."

Since Henry's order was made, the province and its partners have been working to meet the conditions in the order. This includes creating regulatory changes and developing the protocols, systems and comprehensive training plans needed from the ground up. As B.C. is the first province in Canada to authorize RNs and RPNs to prescribe controlled drugs and substances, this work has been complex, as it involves many aspects of the health-care system and nursing practice.

Given the complexities of opioid use disorder and OAT, Henry's order stated that RNs and RPNs must meet numerous requirements before they can begin prescribing. This involves completing training established by the BC Centre on Substance Use, including in-person mentoring with experienced prescribers. Additionally, work has been happening behind the scenes to create the necessary prescribing standards through the BC College of Nurses and Midwives and establishing the regulatory requirements needed for RNs and RPNs to diagnose, order, refer and prescribe.

Cynthia Johansen, registrar and CEO for the BC College of Nurses and Midwives (BCCNM) says, "As the regulatory body for nurses and midwives, we are pleased to ensure that standards are in place to support safe prescribing for opioid use disorder by registered nurses and registered psychiatric nurses. Collaboration across the health care system is key to fighting the overdose crisis, and BCCNM is pleased to be a partner in this life-saving work."

Cheyenne Johnson, interim executive director of the British Columbia Centre on Substance Use, adds: "Nurses play a critical role in connecting people to treatment, representing for many patients the first, and sometimes only, access point to health care. Expanding prescribing to include RNs and RPNs will, for many British Columbians, represent a pathway to addiction treatment and the supports that can follow, from harm reduction to recovery."