Resource
Nurse prescribing
To help address the worsening situation of overdose deaths arising from the dual public health emergencies (overdose death epidemic and COVID-19 pandemic) Dr. Bonnie Henry issued a Provincial Health Officer order on September 16, 2020.
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The Provincial Health Order is limited in time to the duration of the overdose death public health emergency, and authorizes Registered Nurses (RNs) and Registered Psychiatric Nurse (RPNs) who have additional educational preparation and experience to:
- order and interpret diagnostic tests to make a diagnosis of a problem substance use condition or substance use disorder
- make a diagnosis of a problem substance use condition or substance use disorder
- prescribe controlled drugs to people who are diagnosed as having a problem substance use condition or substance use disorder; and
- refer people with a problem substance use condition or substance use disorder to primary care and specialized health and social services
VCH sites piloting nurse prescribing
Nurse prescribing is now being implemented across the VCH region with a total of 10 sites now implementing the practice. Community sites who are interested in bringing nurse prescribing to the team are welcome to send enquires to the Regional Addiction Program.
Medications that can be prescribed
Nurse prescribers can now prescribe all three oral OAT medications. In addition to buprenorphine/naloxone, nurse prescribers can prescribe slow release oral morphine (SROM), and methadone with limitations.
RN/RPN prescribing aims to both increase the capacity of OAT prescribers as well as reach clients who are not accessing existing OAT services. RNs and RPNs will be expected to screen clients for OUD, make a diagnosis of OUD, facilitate discussions about OAT options, and prescribe sublingual buprenorphine/naloxone when appropriate. RN/RPN prescribers will support clients for buprenorphine/naloxone inductions (office-based, home-based, or microdosing), bridging, and continuations.
These activities are subject to the services being provided in the course of a program approved by a medical health officer (MHO) and being conducted in accordance with the standards, limits and conditions of the British Columbia College of Nurses and Midwives (BCCNM) and within the education program and clinical requirements set by the BC Centre on Substance Use (BCCSU).
MHO approval is needed because prescribing under this order flows from the PHO order which is in support of ameliorating the harms and risks of the public health emergencies by providing access to treatment including by providing opioid agonist treatment and by prescribing pharmaceutical alternatives to illegally produced or street procured drugs.
