The Provincial Opioid Addiction Treatment Support Program (POATSP), which launched in July 2017, is the new provincial program for the education and care guidance for the treatment of opioid use disorder, including the authorization section 56 exemptions of the Controlled Drugs and Substances Act to prescribe methadone. The POATSP program also includes buprenorphine/naloxone training for prescribers.

In order to improve access and provincial capacity for opioid agonist treatment education for health professionals, the BCCSU (in partnership with UBC CPD) developed an online learning platform paired with an in-person preceptorship. The online course is free and available for anyone to register – not just those seeking a methadone exemption.

The Provincial Opioid Addiction Treatment Support Program (POATSP) and Online Addiction Medicine Diploma are two separate online training programs developed by the BCCSU. If you are looking for a broad overview of substance use disorders and care including stimulant, alcohol, tobacco, and opioid use disorder you can register for the Online Addiction Medicine Diploma program here.

OVERVIEW    TOPICS COVERED    PROGRAM OUTCOMES

   EXEMPTION REQUIREMENTS    EXEMPTION PROCESS    PRECEPTORSHIP GOALS & PROCESS    PRECEPTORS

FAQs

OVERVIEW

Historically, the College of Physicians and Surgeons of British Columbia (CPSBC) has provided regulation, education and care guidance for opioid agonist treatment (OAT) in the province.

As of June 5, 2017, the BCCSU became responsible for the educational and clinical care guidance activities for all health care professionals who are prescribing medications to treat opioid use disorder (i.e., methadone, buprenorphine/naloxone, slow-release oral morphine). Since its launch, the BCCSU has developed and released a new Provincial Guideline for the Clinical Management of Opioid Use Disorder which is the official guideline for the province.

As part of its regulatory function, the CPSBC will continue their Prescription Review Program in accordance with the core principles for safe and effective prescribing practices as per the CPSBC Standards and Guidelines for the Safe Prescribing of Drugs with Potential Misuse/Diversion. Additionally, the exemption process for prescribers of methadone for analgesia will remain the responsibility of the College of Physicians and Surgeons of BC.

WHO SHOULD TAKE THIS COURSE?

The online training for the Provincial Opioid Addiction Treatment Support Program is geared towards opioid agonist treatment prescribers, including both physicians and nurse practitioners, however, all health care providers (e.g., nurses, pharmacists, social worker, counsellors, etc.) can benefit from the online education modules. Completing this course is the first step in the authorization process for those seeking an exemption to prescribe methadone.

Those not seeking an exemption or CME credits can simply select modules of interest to their profession.

Opportunities for CME credits (includes both MainPro+ and MOC credits)

  • Methadone CME – 4 hours
  • Buprenorphine/naloxone CME – 4 hours
  • Full OAT CME – 8 hours
  • START THE COURSE

TOPICS COVERED

  • Trauma-Informed Care
  • Overview of Opioid Use Disorder
  • Triage, Assessment, and Treatment Planning
  • Urine Drug Testing
  • Harm Reduction
  • Health Promotion for People with Opioid Use Disorder
  • Methadone – Pharmacotherapy, Safety, Continuing Care, and Pregnancy
  • Buprenorphine/Naloxone – Pharmacotherapy, Induction, Continuing Care, and Pregnancy
  • Slow Release Oral Morphine (SROM)
  • Caring for a Patient with Opioid Use Disorder
  • Differences Between Methadone and Buprenorphine
  • Treating Opioid Use Disorder – Rural Context
  • Home Induction of Buprenorphine/Naloxone
  • Polysubstance Use While on Opioid Agonist Treatment
  • Strategies to Prevent Diversion
  • Benzodiazepine Prescribing from Another Prescriber
  • Youth with Opioid Use Disorder
  • Managing Precipitated Withdrawal - Buprenorphine/Naloxone
  • Methadone in Acute Care Settings
  • Buprenorphine/Naloxone in Acute Care Settings
  • Transition from Methadone to Buprenorphine/Naloxone

PROGRAM OUTCOMES

Provide a primarily online-based education curriculum to train physicians and nurse practitioners in British Columbia to diagnose and treat opioid use disorder using evidence-based treatments along a continuum of care.

Learners can select modules based on their learning goals pertaining to methadone, buprenorphine/naloxone, SROM or a combination of these treatments options.

At the end of the course, you will be able to:

  1. Define and establish a diagnosis opioid use disorder
  2. Recognize safe treatment of opioid use disorder with buprenorphine/naloxone or methadone
  3. Write a safe and clear methadone or buprenorphine/naloxone prescription
  4. Describe how to engage a patient in comprehensive and continuing care

EXEMPTION REQUIREMENTS

Full exemption

The process to meet the requirement for full methadone prescribing involves:

  • 8-hour online course (which includes both MainPro+ and MOC CME credits)
  • 2 half-days of preceptorship, completion of the workbook or additional learning as needed
  • PharmaNet review

NOTE: If you have previously completed Methadone 101 through the College of Physicians and Surgeons of BC but have not yet completed a preceptorship or you have completed educational requirements in another province or jurisdiction, please contact:
Amanda Giesler
Project Coordinator, Implementation
(604) 416-1535
agiesler@cfenet.ubc.ca

Temporary exemption

The process to meet the requirement for temporary methadone prescribing involves:

  • 1-hour online course (particular modules within the full course)
  • Responding to the BCCSU follow-up with some basic information
  • PharmaNet review

Regulatory differences between a full exemption and a temporary exemption for OUD

Note: With a temporary exemption for methadone for analgesia (administered through the College), dose alterations are permitted but inductions cannot be provided.

Hospitalist prescribers no longer require temporary exemptions to prescribe methadone for opioid use disorder.

The BCCSU is also working with the College of Registered Nurses of BC (CRNBC) to optimize the methadone exemption process for nurse practitioners as the authorization to prescribe full OAT takes effect.

EXEMPTION PROCESS

  • The course is divided into 24 modules and takes approximately 8 hours to complete.
  • After registering for the course, you will be prompted to order your prescription pads from College to help ensure you can receive these in time to start prescribing.
  • Once you have completed your online learning, you will have to complete a Preceptorship Form and complete either the Community or Hospital Based Workbook (both of these links are provided at the end of the course).
  • The BCCSU mandates the completion of a preceptorship of at least two half-day sessions before an application for an authorization to prescribe methadone (i.e., a full methadone exemption) for the treatment of opioid use disorder can be considered.
  • After completion of the preceptorship, a PharmaNet review will be conducted by the College of Physicians and Surgeons of BC.
  • If there are no concerns, the College will activate PharmaNet and the BCCSU will process your exemption with Health Canada.
  • You will be notified by the BCCSU of your successful completion of all the course requirements. Please note that it takes 1-2 business days for this upload between the College and PharmaNet to occur and for the prescriptions to start going through in the system.

PRECEPTORSHIP GOALS AND PROCESS

The goal of the BCCSU preceptorship program is to promote understanding and application of the new provincial Guideline for the Clinical Management of Opioid Use Disorder in a supervised clinical setting. In order to complete the preceptorship requirement to obtain a methadone exemption (or for buprenorphine/naloxone prescribing for nurse practitioners):

  1. Applicants must select a name from the list of approved preceptors that is provided upon completion of the online modules of the Provincial Opioid Addiction Treatment Program and contact the chosen preceptor’s office directly to confirm availability. The applicant must report the scheduling of this preceptorship through an online survey-tool (links provided after completion).
  2. Applicants must print out and complete either the Hospital-Based or Community- Based Case Workbook before the scheduled preceptorship. This workbook will be reviewed together with the preceptor throughout the two half-day sessions.
  3. During the two half-day sessions, the preceptor will be required to complete a review of the workbook, ensure the diversion agreement is signed, and provide the BCCSU with their assessment of whether or not to recommend the prescriber for a federal section 56 exemption. This will be done through a secure online form sent to the BCCSU directly by the preceptor.
  4. The BCCSU will then contact the applicant regarding successful or unsuccessful completion of the preceptorship and to address any concerns brought forth in the preceptorship.

PRECEPTORS

We are expanding the number of opioid agonist treatment preceptors in the province. If you are interested in becoming a preceptor, please contact:
Amanda Giesler
Project Coordinator, Implementation
(604) 416-1535
agiesler@cfenet.ubc.ca

FAQ's

Those who have completed a Methadone 101 course from October 1, 2016 (Vancouver session) onwards will not be required to complete the additional online training at this time. Please send a copy of the certificate of completion to Amanda Giesler (agiesler@cfenet.ubc.ca) to be linked to preceptorship opportunities.

No. The Methadone 101 sessions hosted by the College of Physicians and Surgeons of BC has been replaced with the BCCSU’s online education modules. In addition to the online modules, the RACE line is also available to provide additional addiction medicine expert support.

No. A temporary exemption, which is non-renewable and valid for 60 days, is available for methadone maintenance and re-ordering only.

At this time, physicians and nurse practitioners (NPs) do not require an exemption to prescribe buprenorphine/naloxone. However, physicians interested in prescribing buprenorphine/naloxone are strongly encouraged to complete the modules pertaining to this medication (CME accredited) before starting to prescribe.

Nurse practitioners (NPs) who meet the regulatory requirements for NP prescribing of controlled drugs and substances in BC must follow the standards, limits and conditions for the continuation of buprenorphine/naloxone for the treatment of opioid use disorder.

Note: the scope of NP prescribing of opioid agonist treatment in BC is in the process of being expanded to include initiation of buprenorphine/naloxone and continuation and initiation of methadone.

Physicians – this is not required but is available for prescribers who would like extra support before prescribing

Nurse practitioners – this is a requirement as per CRNBC standards, limits and conditions

At this time, physicians do not require an exemption to prescribe slow-release oral morphine, although it is strongly recommended that they hold a valid federal Section 56 exemption.

For prescribers who intend to take on this more advanced prescribing, there is a specific module available in the online course to support your practice. It is also recommended that clinicians complete a preceptorship with a preceptor who has specific experience with that medication. When scheduling a preceptorship, the list of preceptors also includes which medications they routinely prescribe.

Preceptors will assist in the training and mentoring of new prescribers. The BCCSU has developed a process to select preceptors across the province (i.e. each health authority) to ensure adequate coverage to meet the needs for recruiting new prescribers, including nurse practitioners. BCCSU preceptors must meet the following criteria:

  1. At least three years’ experience in the Methadone Maintenance Program with minimum 20 registered patients and a practice that includes routine inductions
  2. An acceptable PharmaNet review (as per the CPSBC Standards and Guidelines for Safe Prescribing of Drugs with Potential for Misuse/Diversion)
  3. Clinical practice adherence to the BCCSU’s Guideline for the Clinical Management of Opioid Use Disorder

Preceptors will be provided with comprehensive training regarding their role and responsibilities. Further, preceptors will be compensated $200 per half-day of teaching and for training sessions required by the BCCSU.

Copyright © 2016, British Columbia Centre on Substance Use

608-1081 Burrard Street, Vancouver, BC V6Z 1Y6

E: bccsu@cfenet.ubc.ca | T: (604) 806-9142 | F: (604) 806-9044