Guidance Release – We are pleased to announce that the "Risk Mitigation Guidance in the Context of Dual Public Emergencies" and new "Opioid Use Disorder: Practice Update" have now been approved by the Ministries of Health and Mental Health & Addiction. As the COVID-19 pandemic and overdose emergency continue to evolve, updated clinical guidance has been needed to support clinicians and people who rely on the unregulated drug supply. In combination, these documents provide prescribers with further clinical guidance to support ongoing care for their patients at risk of overdose and/or COVID-19 infection.
You can find the new guidance and supporting documents here:
- RMG: https://www.bccsu.ca/wp-content/uploads/2022/01/Risk-Mitigation-Guidance-Update-January-2022.pdf
- OUDPU: https://www.bccsu.ca/wp-content/uploads/2022/01/Opioid-Use-Disorder-Practice-Update-January-2022.pdf
- FAQ: https://www.bccsu.ca/wp-content/uploads/2022/01/FAQ-RMG-OUDPU.pdf
- Summary: https://www.bccsu.ca/wp-content/uploads/2022/01/Summary-RMG-OUDPU.pdf
If you are interested in joining a community of practice for prescribed safer supply, there is a National Safer Supply Community of Practice supported by funding from Health Canada's Substance Use and Addictions Program. It is a collaborative project between London InterCommunity Health Centre, Canada Association of People who Use Drugs, and the Alliance for Healthier Communities. To join the CoP, email: [email protected] or join the Google Group (listserv) to communicate with other members.
You may also direct questions to the 24/7 Addiction Medicine Clinician Support Line in order to receive consultative advice from an addiction medicine specialist (phone 778-945-7619) or, for general and less time-sensitive inquiries, by emailing [email protected].
The increasing infiltration of benzodiazepines in the street drug supply is presenting incredible challenges to both clinical management and individual safety.
We wanted to provide an overview of recent data, some clinical tips regarding using urine drug tests to identify benzodiazepine exposure, and encourage prescribers to access the 24/7 Line for case-based consultation.
- The presence of benzodiazepines and benzodiazepine analogues in the street drug supply is increasing.
- From July 2020 to October 2021, 44% of samples were positive for at least 1 benzodiazepine.
- Benzodiazepine-positive samples increased from 15% in July 2020 to 53% in October 2021.
- Etizolam was detected in 41% of samples between July 2020 and October 2021.
- Data from drug checking services in Island Health show that 78% of expected opioid samples from
- From May to November 2021, 78% of expected opioid samples contained benzodiazepines or etizolam, according to drug checking services in Island Health
- Both the patient and clinician may be unaware that benzodiazepines have been taken and that the patient is at risk of or experiencing benzodiazepine withdrawal.
- People who use illicit opioids are increasingly likely to unintentionally use mixtures of potent opioids and benzodiazepines. (See Laing, 2021, attached)
- Standard point-of-care urine drug tests can detect some types of benzodiazepines, while other benzodiazepines and benzodiazepine analogues (e.g., alprazolam, clonazepam, etizolam, temazepam, triazolam) may not be detected.
- Drug-checking data suggest that etizolam may only be detectable on point of care test strips in higher concentrations than what is typical of other benzodiazepines. (See Shapiro, 2020, attached)
- Substantial false positive (15.5%) and false negative (37.5%) rates for novel benzodiazepines have been found when using point-of-care test strips.
- What this means: a urine drug test negative for benzodiazepines and analogues does not mean that a given patient is not at risk of benzodiazepine withdrawal.
- Clinicians should monitor patients who discontinue illicit opioid use, including those who start opioid agonist treatment (OAT) for signs and symptoms of benzodiazepine withdrawal.
- There is a risk of severe withdrawal symptoms, including seizures, if benzodiazepine withdrawal is not identified and managed.
- Due to the overlapping symptoms of opioid and benzodiazepine withdrawal, it may be challenging to assess the severity of withdrawal from each substance.
- If benzodiazepine withdrawal is suspected, clinicians are encouraged to provide supportive care and contact the 24/7 Addiction Medicine Clinician Support Line orthe RACE App for case-based consultation.
- See attached Benzodiazepines and Opioids Bulletin for additional guidance.
There are two key changes to Risk Mitigation and Opioid Use Disorder: Practice Update based on feedback since they were released.
- The text on page 24 of the Opioid Use Disorder: Practice Update was included in error. It was meant to provide instructions only on when the “SA” code should be added to prescriptions for prescribed safer supply; however, it included additional medications that are not included in the guidance. We understand this may have led to confusion. The updated text includes only the two medications (hydromorphone and M-Eslon) included in the guidance document.
- The footnote on p. 19 of the Opioid Use Disorder: Practice Update and p. 24 of the Risk Mitigation Update regarding urine drug testing has been updated to provide more clarity. It now reads:
“Note that UDTs consistently negative for illicit substances are not required in order to continue this intervention. Given the extremely high potency opioids in the illicit drug supply, many individuals may continue to use a combination of prescribed hydromorphone and illicit opioids. In the case of UDTs negative for the prescribed substance (e.g., hydromorphone), prescribers should use clinical judgement to determine if it is appropriate to continue prescribing based on an assessment of the risks and benefits and discussion with the patient. It is recognized that each dose of prescribed, regulated opioids reduces risk of overdose.”
Finally, we’d like to provide some additional information on the utility and rationale for adding the “SA” code to prescriptions:
In addition to enabling evaluation efforts, which will be used to inform future clinical guidance and program planning, adding the “SA” code to prescriptions will support the regulatory colleges to better understand prescribing practices, including identifying when certain medications are prescribed for safer supply rather than other narcotic prescribing (e.g., for pain). This added information will help reduce the need for additional clarity to be sought by the regulatory colleges.
Paxlovid Drug–drug Interactions: Paxlovid, a combination of two antiviral drugs—nirmatrelvir and ritonavir—authorized by Health Canada to treat adults with mild-to-moderate COVID infection who are at high risk of progressing to serious disease, has a number of potential drug–drug interactions you should be aware of, including some opioids and benzodiazepines.
- Paxlovid may decrease serum levels of methadone by 20–40%; while empiric dose adjustments are not recommended, individuals receiving both methadone and Paxlovid should be monitored for emergence of cravings or withdrawal symptoms.
- Paxlovid can have a mixed interaction with morphine, increasing some metabolites and decreasing others; individuals on slow-release oral morphine should be monitored for toxicity/efficacy.
- Paxlovid has a serious interaction with fentanyl, leading to significantly increased serum concentrations and an increased risk of respiratory depression; individuals who are receiving Paxlovid and use illicit fentanyl should be counselled on the significant risk and provided safer use strategies (e.g., avoid using alone, use a smaller amount than normal).
- Paxlovid can increase the potency of several benzodiazepine receptor agonists (BZRA), including clonazepam and zopiclone; reducing many BZRA doses by 25–50% or holding PRN doses should be considered during co-administration with Paxlovid and for 2–3 days after Paxlovid is stopped. Because the illicit opioid supply is increasingly adulerated with benzodiazepines, individuals should be counselled on the significant risk and provided safer use strategies (e.g., avoid using alone, use smaller amounts than normal).
- See Practice Tool #3—Drug–drug Interactions and Contraindications from the BCCDC for more information or call the COVID-19 Antiviral Support Line for Clinicians (M-F 8:30am-4:30pm) at 1-866-604-5924.
POATSP Preceptor Call-out Are you interested in helping to train and mentor new OAT prescribers? We are looking for new preceptors. If you’re interested, have been prescribing OAT for at least 3 years including routine OAT initiations, and practice in alignment with the Guideline for the Clinical Management of Opioid Use Disorder, please email [email protected] to receive the application form.
Duplicate CPP Forms Just a quick reminder that original CPP forms must be sent to pharmacy in a timely manner in the case that verbal orders or faxed prescriptions are sent.
Prescribed Safer Supply Community of Practice The Ministry of Mental Health and Addictions has formed a Community of Practice focused on Prescribed Safer Supply in BCC (BC-PSS-CoP). Please see details from MMHA below:
The BC-PSS-CoP will be hosted by the Ministry of Mental Health and Addictions. It will:
- Provide opportunities for support, reflection, and information sharing among clinicians and allied health professionals offering PSS
- Discuss emerging evaluation and monitoring reports, clinical, epidemiological and other data trends, and evidence development updates for PSS
- To discuss clinical scenarios for optimal patient care, practice improvement and practice support
If you are interested in joining the BC-PSS-CoP, please email [email protected] to be added to the invite list.
Clinical Tip - Naltrexone is contraindicated for individuals on OAT, as it is an opioid antagonist that will cause precipitated withdrawal if taken by a person on OAT. However, this drug-drug interaction can be missed. For example, in a scenario in which a patient sees one clinician for primary care and another for OAT, a co-prescription and drug-drug interaction may not be flagged by PharmaNet. We have seen a few cases pop up here in BC where naltrexone was prescribed for the treatment of alcohol use disorder for a person also receiving OAT. Therefore, please consider extra vigilance to ensure that these two medications are not co-prescribed. It is also important to ask about any over-the-counter pain medication use that may interact with naltrexone (for example, codeine-containing preparations such as Tylenol #1).
1 – AUD Pregnancy Supplement Release – Our team here at the BCCSU has just publicly released a new clinical guideline supplement to care for pregnant people who use alcohol. This document provides specific tools and approaches to substance-use care for clients during pregnancy and aims to improve overall health outcomes and a better likelihood of longer-term engagement in care. You can check out the press release here:https://news.gov.bc.ca/releases/2021MMHA0008-000417 and you can find the supplementary guidance here: https://www.bccsu.ca/alcohol-use-disorder/
2 – Clinical Tip – BENZOS – As you may recall, we’ve sent out prescriber blasts in the past with alerts regarding the increasing prevalence of benzodiazepines in the illicit drug supply. The data in the most recent coroners report suggests that benzo contamination has rapidly increased up to 49% of samples in January 2021 compared to 15% in July 2020 (you can check out the full report here: https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/news-and-updates). Given this concerning increase, it’s important that you are all aware and is a good reminder about the need to listen to patients and to do our best to navigate through a challenging situation in a collaborative and safe way. Our drug checking team here at the BCCSU has also provided their findings (attached) highlighting important trends over the past 6 months and many of the specifics that you might find helpful. Lastly, I’ve attached the etizolam factsheet created by the BCCDC for more information about this concerning benzo in the current illicit supply.
4 – Nurse Prescribing Platform Launch - We’re pleased to announce that the Provincial Opioid Addiction Treatment Support Program: Registered Nurses and Registered Psychiatric Nurses online course has launched and is available for registered nurses (RNs) and registered psychiatric nurses (RPNs) to take. This online course is the first step of the education pathway for RN and RPNs to make a diagnosis of opioid use disorder (OUD), prescribe buprenorphine/naloxone, order certain tests, and provide monitoring and follow-up for individuals with OUD. Here is the link to register: https://ubccpd.ca/course/provincial-opioid-addiction-treatment-support-program however, please note that RNs and RPNs that wish to prescribe must seek formal authorization from their organization (e.g., from supervisors and organizational leaders) before starting this pathway. Please feel free to share this with your nursing colleagues and have them direct any additional questions to [email protected].
1 – Plan G Updates - Registered nurses (RN) and registered psychiatric nurses (RPN) in BC can now register patients, to whom they are prescribing buprenorphine/naloxone, for PharmaCare’s Plan G (Psychiatric Medications Plan). Plan G covers the full cost of OAT (and certain other psychiatric medications) for anyone who has clinical and financial need and is enrolled in BC Medical Services Plan (MSP). Until last month, only a patient’s physician or nurse practitioner had the legal authority to complete the Plan G application. You may receive questions about this from your nursing colleagues as more nurses begin to offer buprenorphine/naloxone here in BC.
1 – Managing Co-occuring Opioid and Alcohol Use Disorders – As you know, concurrent use of alcohol and opioids, including opioid agonist therapy (OAT), is associated with an increased risk of respiratory depression, overdose, and death. To help support your practice in this area, our team here at the BCCSU has put together a short clinical resource to help guide decision making as it relates to treating co-occuring opioid and alcohol use disorders. This document provides a brief overview of evidence-based screening
and treatment options in reference to the published provincial guidelines. I’ve attached it for you here and you can also find it at: https://www.bccsu.ca/wp-content/uploads/2021/04/ATG-Managing-Co-occuring-Opioid-and-Alcohol-Use-Disorders.pdf
Nurse prescribing – As many of you are aware, trained RN’s and RPN’s have been prescribing buprenorphine/naloxone in various parts of BC since February of this year. As we learn more about this new scope of practice and how new nurse prescribers link in with physicians and nurse practitioners, we’ve been getting some great questions about it. The BC College of Nurses and Midwives have produced the attached PDF which overviews some of the frequently asked questions. This includes things like “Does consulting with another health professional change or affect a nurse’s accountability and responsibility when prescribing for opioid use disorder (OUD)?”. If you are working with some of the new nurse prescribers here in BC, this is definitely worth the read.
Benzo Bulletin – Our team here at the BCCSU has put together the attached bulletin which highlights the risks associated with the emergence of benzodiazepine-adulterated drugs in the street opioid supply and provides guidance for the care of individuals who have been exposed to benzodiazepines through the use of adulterated opioids. Please note that we’ve really focused this document on benzo-adulterated opioids - the considerations for people prescribed benzos and those with benzo use disorder will be included in the forthcoming benzo think twice/FAQ document.
UDTs – Our colleagues over in Interior Health wanted to share a clinical tip related to confirmatory testing: “Results of confirmatory testing should be interpreted cautiously. For example, the presence of hydromorphone may be due to high levels of morphine (e.g., in patients prescribed slow-release oral morphine) and does not necessarily indicate hydromorphone has been taken. To support your clinical interpretation of UDT results for patients on SROM, if you get back confirmatory testing results that include hydromorphone, you can call the lab and ask for the relative amounts. If the relative amounts of hydromorphone are low relative to that of morphine, it suggests that it was not ingested by the patient, but is rather a break down product of the morphine.”
Sublocade – Just a quick reminder that PharmaNet is a dispensation record and not an administration record. This has come up for a number of prescribers in the context of Sublocade, where patients may report not getting the dose even though there is a record of it being dispensed on PharmaNet. This can cause some confusion between providers/pharmacists/patients so flagging here with a reminder that Pharmanet does not necessarily tell you that patients have been administered the medication.
Methadone in the era of illicit fentanyl – METAPHI has released some guidance for Ontario providers related to Methadone for OAT in the context of illicit fentanyl. While not written for our BC audience, you may find some of the recommendations and discussion useful for your practice. You can read it here: https://www.metaphi.ca/assets/documents/provider%20tools/MethadoneForFentanyl_Draft.pdf
NEW Urine Drug Testing Guidance and Education – Released today by the BCCSU, the Urine Drug Testing Breakout Resource provides guidance for the use of UDT in the primary care management of patients with OUD who are receiving oral OAT (i.e., buprenorphine/naloxone, methadone, or slow-release oral morphine), and offers guidance and general practices for ordering, collecting, and interpreting UDT. Brief guidance on the use of UDT for patients who are receiving injectable OAT is also provided. Please see attached for the full resource as well as a very short summary for your convenience.
With this release, the Urine Drug Testing Module has been updated in the Provincial Opioid Addiction Treatment Support Program to align with this new guidance. This interactive module focuses on practical strategies for incorporating patient-centred care and helpful tips to integrate UDT in treatment planning. Find it here: https://elearning.ubccpd.ca/mod/lesson/view.php?id=9572
Plan G Bridge Coverage – As you may have seen in the July 6 PharmaCare Newsletter, Plan G Bridge Coverage is now available to provide patients with faster, temporary Plan G coverage. Practitioners in emergency departments (EDs), Rapid Access Addiction Clinics (RAACs), urgent primary care centres (UPCCs), and correctional centres (both provincial and federal) can apply for Plan G bridge coverage, using a new section of the Plan G form. Practitioners can then send the form directly to Health Insurance BC instead of a mental health and substance use centre. Plan G bridge coverage is provided to patients for 3 months, during which, to continue coverage, patients are to see a practitioner in their community to apply for regular Plan G coverage. This new process should provide patients who need immediate Plan G coverage with the coverage they need, and enough time to connect with a prescriber in the community to apply for regular Plan G coverage.
The new Plan G Application Form (to be used for regular, exceptional, and bridge Plan G coverage) is now available here:
A guide to Applying for Plan G Bridge Coverage has also been created to help explain the bridge coverage application process, and is available here:
BCCSU Annual Education Report – Want to learn more about all of the various education and training activities led by the BCCSU? Check out the recently published annual education report, which describes how health care professionals from various disciplines have benefited from our educational programs. Read the report here: BCCSU Annual Education Report 2020/21
Risk Mitigation Update – Our team is continuing to work on an update to the clinical guidance “Risk Mitigation in the Context of Dual Public Health Emergencies”. This update will incorporate clinical experience and evidence-to-date in order to reduce risk of overdose while supporting people to self-isolate as the COVID-19 pandemic and public health response continue to evolve. The updated guidance is going through the final stages of review and is anticipated to be released this month. We’ll share a separate update with details at that time.
Prescription Checklist – Attached below is a PDF that overviews the key information to include on the new harmonized controlled prescription program forms, based on errors that are commonly encountered. This may be a helpful resource to you, your admin staff, learning clinicians, or anyone on your team reviewing prescriptions before they are sent to the pharmacy.
Risk Mitigation and OUD Practice Update - Updates to “Risk Mitigation in the Context of Dual Public Health Emergencies” are currently being reviewed by Ministry of Health and Ministry of Mental Health and Addictions. These updates incorporate clinical experience and evidence-to-date in order to reduce risk of overdose while supporting people to self-isolate or quarantine as the COVID-19 pandemic and public health response continue to evolve. In addition, the BCCSU has developed an opioid use disorder practice update, which will be released alongside the RMG update and will provide updates to opioid agonist treatment care (e.g., micro-dosing inductions), as well as additional clinical tools for prescribers to support continued care for patients with OUD. The timeline for release of both documents is still to be determined, but we will share a separate update with the specific documents and details when ready.
Addiction Practice Pod - The BCCSU is excited to announce that the Addiction Practice Pod is back for season 2. The Addiction Practice Pod is a podcast for health care providers in BC and Yukon. We interview clinicians, researchers, and people with lived experience to discuss approaches to addiction care and treatment that work. Listen to season 2, episode 1: Substance Use Care in Rural and Remote Contexts.
Youth Support - As the holidays can be a challenging time for some young people, Foundry Virtual BC, offers a provincial service for young people aged 12-24 across BC. Services offered include drop-in and scheduled counselling & peer support, primary care, employment support and groups. All services are free, confidential, and do not require a referral to access. Please find attached a few resources (one-pager for service providers, poster for youth and poster for caregivers) and you can email [email protected] if you have any questions regarding this service.
Nurse Prescribing – Last month, the BCCSU launched its new education and training pathway for RN/RPN’s looking to prescribe buprenorphine/naloxone plus limited prescribing of methadone and SROM. Several nurses have been enrolled into this pathway since launch and it’s important that you all know about this expanded scope of practice, and be aware of how you can support and work together as a care team in your regions. If you have any questions about nurse prescribing, please email [email protected].
College Reviews of Pandemic Prescribing Risk Mitigation - As you aware, the College of Physicians and Surgeons of BC has a mandate under the Health Professions Act to monitor the prescribing of physicians in the province of BC in order to ensure that it adheres to relevant standards and guidelines. In the context of Pandemic Prescribing Risk Mitigation (PPRM), this has become uniquely challenging, given that this new approach (which the College has been supportive of) represents a significant departure from usual practice patterns. Specifically, Pharmanet’s Practitioner Prescription Profile is now a less-reliable tool to survey prescribing and identify those who might qualify for a more careful evaluation. To that end, we’ve been notified that the College has been reaching out to some prescribers with a list of questions, including an outline on approaches, experience, and clinic policies when prescribing OAT and PPRM. This is an information gathering process to learn about prescribing practices, safety measures, and overall care when treating patients with substance use disorders. This is not meant to be an “audit” in the traditional sense. Should you be contacted, the process is not meant to be arduous and the College hopes that these interactions will allow for education in both directions, in order to continuously improve on a very new area of practice. We thought it was important to inform you this was happening and to support a mutual goal of ensuring the safety of patients and the public.
Methadone Formulations – As of December 17, 2019, a third regular benefit methadone option (made by Sterinova and distributed by Sandoz) became available in BC. Sandoz Methadone (Sterinova) is cherry-flavoured and uses blue dye, which may be beneficial for patients who have experienced an adverse reaction to the red dye in Methadose. In considering your full suite of options with patients, you have Methadose, Metadol-D, and Sandoz Methadone (Sterinova) covered for those enrolled in PharmaCare Plan C (Income Assistance), Plan G (Psychiatric Medications), and Plan W (First Nations Health Benefits), as well as compounded methadone as a last-resort option for individuals who have trialed regular benefit formulations without success. See attachments for information on each of the methadone formulation options and guidance on formulation selection.
BC ECHO on Substance Use – This virtual program aims to help primary care providers and their teams across BC and the Yukon connect to discuss treatment and management of opioid use disorder.
You can get involved in ECHO in any of the following ways:
- Attend the bi-weekly sessions and contribute patient cases for discussion
- Sign up to lead an ECHO session in a future cycle (next one planned for Summer-Fall 2020)
- Share this information within your network and invite others to join
Flubromazepam/flualprazolam – We’ve been getting a few requests to share some information regarding benzos that have been present in the drug supply over the past few months. I’m attaching a couple papers here for your own learning about these designer benzos, since the combination with fentanyl can cause a more severe kind of overdose. The presence of these benzos has been confirmed by our drug checking teams and they would be happy to provide more information if you need it.
COVID-19 and OAT - In the context of the COVID-19 pandemic, there are additional considerations for access that prescribers and pharmacists should be aware of. For example, immunocompromised patients and those who exhibit symptoms or are under quarantine or self-isolation may not be able to attend medical appointments or present to the pharmacy for their witnessed dose or to pick up their carries. To facilitate continued access to OAT medications all health care providers should read the attached guidance for our specific recommendations. You can also access it here: https://www.bccsu.ca/wp-content/uploads/2020/03/COVID-19-Bulletin-March-17-2020.pdf We are envisioning this as a living document and anticipate we will update it regularly as new information becomes available. We are also drafting some patient facing material with general advice for people who use drugs about COVID-19, as well as specific suggestions for those on OAT.
Kadian Shortage - There is potential shortage in your area of some dosage strengths of slow-release oral morphine (SROM), brand name Kadian for the treatment of opioid use disorder. More information can be accessed via the website https://www.drugshortagescanada.ca; search records for “Kadian”. There may be a backlog of orders yet to be delivered at select pharmacies, so your patients may be reporting that their pharmacies cannot fill their prescriptions. As of today, there is very limited Kadian supply for ordering in all strengths. Please see the attached alert for clinical guidance but I will send you an updated alert as soon as we have more information and should the supply change.
Professional Practice Policy 71 – Delivery of OAT – The College of Pharmacists of British Columbia has approved the new PPP-71 which most notably removes the requirement for physician authorization for delivery and allows a pharmacist to use their professional judgement to decide to deliver OAT to a patient (together with appropriate communication to the prescriber). You can read the summary of changes here: https://www.bcpharmacists.org/board-highlights-february-14-2020#PPP-71 which are planned to come into effect on April 1, 2020.
Addiction Care and Treatment Online Certificate - On behalf of the BCCSU and UBC CPD team, we are pleased to announce the launch of "Module 19: Pregnancy and Substance Use Disorders", which is now available as part of the Addiction Care and Treatment Online Certificate (ACTOC). Find it here: https://elearning.ubccpd.ca/mod/lesson/view.php?id=4912&pageid=8813
If you haven’t already registered for our ACTOC course, you can do so here to access the new module: https://ubccpd.ca/course/addiction-care-and-treatment
This module underscores the importance of care for substance use disorders during pregnancy. Learners will be guided through the best practices of substance use care throughout pregnancy to postpartum. The treatment approaches for alcohol, opioid, and tobacco disorders are discussed, aligning with the most recent evidence-based guidelines. We also extend our sincere thanks to the team at the BC Women’s and Health Centre for their support of this project, bringing to life an educational module that will reach thousands of clinicians in our province.
Updated Resources – Just a reminder that this single link has a bunch of handy resources for you related to COVID: https://www.bccsu.ca/resources-substance-use-and-covid-19/
AUD Resources – Our team has developed a nice AUD resources page that has bulletins, pathways, and tables that you can use to support your practice. I’m attaching the AUD pharmacotherapy tables here as I think many of you will find them helpful and may wish to print them off in your clinic. You can access all the resources here: https://www.bccsu.ca/alcohol-use-disorder/
Patient Handouts – Our team also created some patient facing materials that speak to COVID-19 and Pandemic Prescribing during this time. Feel free to send to your staff/MOA/front desk to have these available for patients if you are currently prescribing these options. I’ve attached the poster and the postcards to this email but you can find all the COVID resources here: https://www.bccsu.ca/covid-19/
Sublocade Guidance – Sublocade is an extended-release formulation of buprenorphine that is administered monthly via abdominal subcutaneous injection for the management of moderate to severe opioid use disorder. As you may have seen, Sublocade was made available in British Columbia on April 30, 2020, through Pharmacare Special Authority. I’ve attached an important bulletin that provides information for prescribers and pharmacists including guidance on how to prescribe, instructions for submitting a Special Authority request form to PharmaCare, and available education and training. You can also find the bulletin here: https://www.bccsu.ca/wp-content/uploads/2020/05/Bulletin-Sublocade_May6.pdf
Provincial Alert – Effective today, Toward the Heart has released an alert regarding increased drug toxicity in stimulants and opioids over the past few weeks. Reports since March 22nd are showing more severe and more frequent overdoses. Please feel free to send the attached poster to your clinic staff or print so your patients are also aware.
ACTOC Module Launch – we are pleased to announce a brand new module addition into our Addiction Care and Treatment Online Certificate (ACTOC), that officially launched today. This module is the “Substance Use Care for Two-Spirit, Lesbian, Gay, Bisexual, Trans, Queer, and Other Sexual Gender Diverse (2SLGBTQ+) People” and can be accessed here: https://elearning.ubccpd.ca/mod/lesson/view.php?id=7913&pageid=12360
Substance Use Care for 2SLGBTQ+ People was developed in response to ongoing research highlighting the factors that place these communities at a disproportionately high-risk of substance use-related harms, and an urgent need to improve patient-centered care. Through eight guiding principles, this module provides a framework for substance use care for 2SLGBTQ+ people that clinicians can apply in practice to provide improved and inclusive care.
We would like to extend our gratitude to Nina Chhita, Josey Ross, Kate Campbell, Armin Mortazavi, Dr. Rod Knight, A.J. Lowik, Peter Hoong, Rodney Stehr, and our many reviewers for their crucial contributions to this module.
BC Substance Use Conference – Virtual Series – Just wanted to follow up to let you all know that we were able to record all four sessions in our virtual series, and have put them online with all the slides, resources, and additional questions that couldn’t be addressed in our limited time together. As a reminder, we covered pregnancy and substance use, older adults and substance use, rural and remote considerations, and pandemic prescribing.
If you watch the recording, you can claim self-learning CME credits: https://ubccpd.ca/accreditation/self-learning
24/7 Addiction Medicine Clinician Support Line – I just wanted to send a reminder about this important service that is fully operational and is an excellent resource for some consultation. I highly encourage sending this around to your networks as there are still folks unaware that this is available and accessible 24 hours a day, 7 days a week to provide rapid response for time sensitive clinical substance use inquiries. To call the 24/7 Addiction Medicine Clinician Support Line and speak to an Addiction Medicine Specialist, call 778-945-7619 or visit www.bccsu.ca/24-7 for more information.
Methadone Table – We have created a really handy methadone formulations chart with the options currently available in BC. The chart can be used across multiple settings and provides key details for each methadone formulation, which ones are available as regular PharmaCare benefits, and the preparation information. This works really well as a printed copy for your clinic or to have on file as a resource when needed. The table was adapted with thanks from Mona Kwong’s work and you can find it in the attachments.
Supportive Recovery Services in BC - To support individuals and families in locating recovery services during the COVID-19 pandemic, BCCSU, MMHA and MOH have partnered to develop a detailed list of bed-based treatment and recovery services. This publicly available list will be located on the BCCSU website here: https://www.bccsu.ca/recovery_services_in_bc/.
As a public resource, the list is an easily accessible tool for individuals to find service options available in their community. This list clearly distinguishes services that are operating under the oversight of health authorities or the Assisted Living Registry. Services not on this list may be providing a different type of service (e.g. supportive housing) or operating unlawfully. In addition to contact information and links to service provider websites, the list also confirms which service providers accept clients on opioid agonist treatment, and any sex or age restrictions. People are encouraged to reach out to services directly should they have further questions in order to guide their decision making and to determine if the service fits with their recovery goals.
4 - Guidance released through the CRISM network - There have been a number of guidance documents released by CRISM over the past few months so I’ve listed them here for you with links in case you’d like to check them out:
- Medications and other clinical approaches to support physical distancing for people who use substances during the COVID-19 pandemic (lead: BC node) - https://crism.ca/wp-content/uploads/2020/06/CRISM-Guidance-Medications-and-other-clinical-approaches-22062020-final.pdf
- Supporting People Who Use Substances in Emergency Shelter Settings (lead: Prairies node) - https://crism.ca/wp-content/uploads/2020/05/CRISM-Guidance-Supporting-People-Who-Use-Substances-in-Emergency-Shelter-Settings-V1.pdf
- Telemedicine Support for Addiction Services (lead: Quebec/Atlantic node) –https://crism.ca/wp-content/uploads/2020/05/CRISM-National-Rapid-Guidance-Telemedicine-V1.pdf
- Supporting people who use substances in acute care settings during the COVID-19 pandemic (lead: Prairies node) - https://crism.ca/wp-content/uploads/2020/06/Supporting-People-Who-Use-Substances-in-Acute-Care-Settings-during-the-COVID-19-Pandemic-CRISM-Interim-Guidance-Document-12062020.pdf
1 – Sublocade - If you have prescribed Sublocade for your patients this month, you may have been made aware of some potential shortage challenges or backlogs with your local pharmacies. Yesterday, we received word that Sublocade shipments would resume today and that any backlog issues occurring in BC would be resolved in the coming week. If anything should change, we will be in touch with updates with regards to managing your patients on this medication. In the meantime, please do let us know if any supply issues persist in your communities and we can help connect you further to get those resolved.
For guidance on Sublocade: https://www.bccsu.ca/wp-content/uploads/2020/05/Bulletin-Sublocade_0511.pdf
For education on Sublocade: https://www.bccsu.ca/blog/event/webinars-sublocade/2 – Vivitrol – We have recently been made aware that Vivitrol is no longer available in Canada through the Special Access Program as of Spring 2019. The company did not pursue further commercialization with Health Canada for new starts but will continue providing Vivitrol for any patient that was approved through SAP before the time of closure. We will let you know if this changes in the future.
Billing Changes – You may have seen some tweaks made to the 00039 OAT billing code to accommodate pandemic prescribing. I’ve highlighted the specific changes in this code for you below, but have also attached just a quick snapshot of important OAT codes that have changed with COVID/telehealth as well. Let me know if any substance use billing code issues are persisting in your practice.
P00039 Management of Maintenance Opioid Agonist Treatment (OAT) for Opioid Use Disorder Management of Ongoing Maintenance Opioid Agonist Treatment for Opioid Use Disorder
- i) The physician does not necessarily have to have direct face-to-face contact with the patient for this fee to be paid.
- ii) 00039 is not the only fee payable for any medically necessary service associated with maintenance opioid agonist treatment for opioid use disorder. This includes but is not limited to the following:
- a) At least one visit (in-person, telephone or video conference) per month with the patient after induction/stabilization on opioid agonist treatment is complete.
- b) At least one in-person visit with the patient every 90 days. Exceptions to this criterion will be considered on an individual basis.
- c) Supervised urine drug screening and interpretation of results.
- d) Simple advice/communication with other allied care providers involved in the patients OAT.
iii) Claims for treatment of co-morbid medical conditions, including psychiatric diagnoses other than substance use disorder, are billable using the applicable visit of service fees. Counselling and visit fees related only to substance use disorder are not payable in addition with the exception of visits required to support Substance Use Risk Mitigation in the context of COVID-19 (claim note record must indicate “COVID-19 risk mitigation”).
- iv) This fee is payable once per week per patient regardless of the number of services per week for management of OAT maintenance.
- . v) This fee is not payable with out of office hours premiums.
- vi) Eligibility to submit claims for this fee item is limited to physicians who are actively supervising the patient’s continuing use of opioid agonist medications for treatment of opioid use disorder.
- vii) This payment stops when the patient stops opioid agonist treatment.
5 – CRISM Guidance – Last month, I sent along 4 key CRISM documents that had been released over the spring/summer and wanted to share two additional resources that were released since my last blast.
- Harm Reduction Worker Safety During the COVID-19 Global Pandemic
- Strategies to Reduce SARS-COV-2 Transmission in Supportive Recovery Programs and Residential Addiction Treatment Services
You can find the original 4 I sent, along with these 2 new ones here: https://crism.ca/projects/covid/
24/7 Addiction Medicine Support Line – We’ve expanded our service to include midwives in the list of professionals that can access addiction medicine consultation through the line. As a reminder, this is 24/7 consult line that can be accessed by physicians, nurse practitioners, nurses, pharmacists and now midwives. The number to call is 778-945-7619.
New Acute Care Stream in POATSP – As part of the provincial LOUD in the ED initiativethat is co-led by the BCCSU, BC Patient Safety and Quality Council, and Ministry of Mental Health and Addictions, we have updated POATSP to include a stream designed for acute care professionals (in-hospital and emergency department clinicians). Two of the updated modules in the stream include Module 23: Opioid Use Disorder and Acute Care Hospital Settings and Module 24: Buprenorphine/naloxone in Acute Care Hospital Settings. As part of Module 24, we have also created a Decision Support Tool for buprenorphine/naloxone starts in the ED, to help guide clinicians through the induction process. Here is the link to take a look at the updated modules:https://elearning.ubccpd.ca/mod/lesson/view.php?id=8621&pageid=13800. I’ve also attached the DST for your reference. Please feel free to share this with your acute care colleagues.
Acamprosate – If you haven’t seen already, acamprosate (one of the recommended treatment options for AUD in BC) is back to showing regular stock availability and is no longer shorted in the province. https://www.drugshortagescanada.ca/shortage/72306
NEW Addiction Practice Pod – The Addiction Practice Pod is a new podcast created for health care providers in British Columbia and Yukon that focuses on addiction and substance use care. It’s hosted by addiction physician Dr. Christy Sutherland and award-winning journalist David P. Ball, and relays practical insight and guidance to clinicians who are working and/or seeking to develop their skills in this area. The first series of six episodes will support primary care providers to deliver evidence-based, compassionate, trauma- and violence-informed care to patients with substance use disorders. A new episode will launch every second Tuesday until December 1, 2020 and you can find more information here: https://blubrry.com/addictionpracticepod/
Carries – Our pharmacy colleagues wanted to share a reminder about blanket authorizations for OAT carries over the holidays: “Prescription authorizations need to be patient-specific, taking into consideration the needs of the individual patient. As such, blanket authorizations applied to more than one patient will cause challenges with your pharmacies and patients. Instructions that authorize carries ‘on holidays’ or ‘when the pharmacy is closed’ are ambiguous and don’t contain enough specificity to determine the number of days you’ve authorized the patient to carry.” Just wanted to send this along in case it helps to minimize any hiccups over the holidays.
Dilaudid supply – This month, there were potential concerns with the provincial supply of Dilaudid 8mg and 4mg tabs. We’ve been informed that wholesalers have adequate stock of generic products until brand is re-stocked in January. We are being kept informed of any potential issues on this matter but please let us know if you are encountering any immediate supply issues for this medication.
RN/RPN prescribing – We wanted to let you all know that we’ve been working with a number of provincial partners on an education and training pathway for RNs and RPNs to prescribe buprenorphine/naloxone in BC, under the PHO order that was announced this past fall. In January, there will be a small cohort of carefully selected and well-supported individuals from each health authority who will be taking this training and starting this new practice. We will keep you informed as more of this work unfolds, but it’s an important consideration as we think about shared care and collaborative models going into 2021.
24/7 Line Pilot Expansion – Effective Monday, December 21st, 2020, the BCCSU expanded the 24/7 Addiction Medicine Clinician Support Line to better support frontline health workers in Indigenous communities. The expansion is a three-month pilot project in partnership with First Nations Health Authority (FNHA) to provide resources to address overdoses, which are disproportionately impacting Indigenous peoples. The service expansion will increase support and access to health care services in Indigenous communities and will function alongside the FNHA’s Virtual Doctor of the Day service. As a reminder, the number to call is 778-945-7619 or visit https://www.bccsu.ca/24-7/ for more information.
New Clinical Guidance - To help reduce the risks to people who use substances, we have announced new clinical guidance, effective immediately, for health-care providers to stem the spread of COVID-19 and respond to the ongoing overdose emergency. To reduce the risk of transmission, the guidance outlines steps that prescribers, pharmacists and care teams can take to support the provision of medications – including safe prescription alternatives to the illicit drug supply – to be delivered directly to patients, along with telemedicine for clinical assessments. Read it here: https://www.bccsu.ca/wp-content/uploads/2020/03/Clinical-Guidance-Risk-Mitigation-in-the-Context-of-Dual-Public-Health-Emergencies.pdf
Prescribing Drugs Under the Controlled Prescription Program - Physical distancing, self-isolation, and quarantine are preventing some patient-clinician interaction, and patients at particular risk are those on opioid medications for chronic pain or those receiving opioid agonist therapy (OAT). In these exceptional times, prescribers are asked to ensure their patients have an unbroken supply of these medications. If it is not possible to meet with a patient face-to-face, prescribers should consider alternative means to getting duplicate prescriptions to pharmacies.
Health Canada has provided temporary exemptions to parts of the Controlled Drugs and Substances Act (CDSA) and its Regulations to permit pharmacists to extend prescriptions, transfer prescriptions, and for pharmacists and pharmacy employees to deliver controlled medications, and to permit prescribers to issue verbal orders for controlled medications. Accordingly, the College of Pharmacists of BC has amended its bylaws relating to the Pharmacy Operations and Drugs Scheduling Act (PODSA) and the Health Professions Act (HPA). During the pandemic, it is now acceptable for prescribers to fax prescriptions, or give verbal prescriptions for controlled drugs to pharmacists, and then deliver (by mail courier or other means) a hard copy of the original duplicate form. It is essential the pharmacists receive the original duplicate form as soon as reasonably possible.
To further enable access to these controlled prescriptions, pharmacists are able to provide emergency supplies of controlled drugs (including OAT). Pharmacists are also able to deliver these medications when it is safe and in the best interest of the patient to do so, which includes practising physical distancing and screening for potential COVID-19 exposure. Information on corresponding College of Pharmacists of BC Bylaw changes can be found here.
Updated Bulletin and Resource Page – As you know, we develop updated clinical guidance for prescribers and pharmacists to improve access to OAT in the context of COVID-19. It can be found here: https://www.bccsu.ca/opioid-use-disorder/. We have also compiled a really helpful resource page that includes information for patients, clinicians, pharmacists, and other service providers. Find it here and feel free to share widely: https://www.bccsu.ca/resources-substance-use-and-covid-19/
Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists - Temporary amendments to Professional Practice Policy-71: Delivery of Opioid Agonist Treatment (PPP-71) that allow pharmacists to authorize regulated health professionals to deliver Opioid Agonist Treatment (OAT), are now in effect. These amendments also allow pharmacists to authorize pharmacy employees, including pharmacy technicians and pharmacy assistants, to deliver OAT on a pharmacist’s behalf in exceptional circumstances where it is not possible for a pharmacist or other regulated health professional to deliver the OAT drug. In the context of COVID-19, the College recognizes the importance of maintaining British Columbians’ access to controlled substances for medical treatments, including OAT. These temporary authorizations come in response to an increased demand for OAT delivery services, including for patients who must self-isolate due to COVID-19, which has placed considerable strain on BC’s pharmacists. You can read more here: https://www.bcpharmacists.org/news/bc%E2%80%99s-covid-19-response-temporary-authorizations-delivery-opioid-agonist-treatment-non
Alcohol Use Disorder and Withdrawal Management - To help mitigate the health risks affecting people with alcohol use disorder and reduce the demand on the healthcare system, I’ve attached a document that provides a brief overview of interventions to prevent alcohol withdrawal symptoms and treat alcohol use disorder while observing social distancing measures. Specifically, this text provides guidance for providing withdrawal management pharmacotherapy and long-term AUD pharmacotherapy in outpatient settings with remote monitoring measures. Additionally, this document provides advice for healthcare providers to support sustained access to alcohol for patients not receiving treatment for alcohol use disorder. You can also find this document and other bulletins here: https://www.bccsu.ca/covid-19/
Webinar Recordings – If you didn’t get a chance to attend any of the pandemic prescribing webinars last week, we’ve got all the recordings available for you here:https://www.bccsu.ca/blog/event/webinars-covid-19-substance-use-and-safer-supply/?event_date=2020-04-09
24/7 Addiction Medicine Clinician Support Line – We are proud to announce the soft launch of our Support Line, which provides telephone consultation to physicians, nurse practitioners, nurses, and pharmacists who are involved in addiction and substance use care and treatment in British Columbia. The Support Line will connect health care providers to an Addiction Medicine Specialist who has expertise and knowledge in addiction medicine (including emergency, acute, and community care). With the ongoing dual public health emergencies (overdoses and COVID-19 pandemic), new clinical guidance, supports, education, and regulatory amendments are being rapidly developed and implemented, which may increase health care provider requests for supports as they work with their care teams and develop necessary care planning. The Support Line is staffed 24 hours a day, 7 days a week, 52 weeks a year to provide rapid response for time sensitive clinical substance use inquiries. To call the 24/7 Addiction Medicine Clinician Support Line and speak to an Addiction Medicine Specialist, call 778-945-7619. The official provincial launch of the Support Line is planned for next Tuesday, June 16. At that time, we’ll be widely promoting this new resource (including the attached promo card, which we ask you not to share before Tuesday) and our resource webpage will go live: www.bccsu.ca/24-7. We wanted to offer you the first opportunity to test the line and please let us know how it goes if you use it – we’d love to know if you found it helpful or had any issues.
Sublocade Series – As you know, the BCCSU and Foundry co-organized a webinar series on Sublocade. This three-part webinar series covered Sublocade administration, practical applications through case-based learning, and a dive into the research. We’ve recorded all these webinars and have them available for you at https://www.bccsu.ca/blog/event/webinars-sublocade/
Pandemic Prescribing FAQ – Throughout the past couple of months, we’ve received an number of questions from you all through our webinars and email regarding the risk mitigation guidance. These were fantastic questions so we decided to create a comprehensive FAQ compiling all of these together so that everyone had access to this information. This is a very helpful resource and worth a read if you’ve had some on-going questions related to the risk mitigation guidance. You can find it here: https://www.bccsu.ca/wp-content/uploads/2020/06/FAQ-Pandemic-Prescribing.pdf
Addiction Care and Treatment Online Certificate (ACTOC)- We are very excited to announce the formal launch of our brand new substance use education program, the Addiction Care and Treatment Online Certificate. This program replaces the Online Addiction Medicine Diploma Program and has been redesigned and updated to bring you a more interactive and seamless learning experience.You’ll find a broad range of substance use disorder modules within the program including alcohol use disorder, stimulant use disorder, cannabis use disorder, and opioid use disorder. The new program has launched in partnership with UBC Continuing Professional Development and the UBC School of Nursing effective today. This program is free and CME accredited (Mainpro+ and MOC Section 3) - check it out and share widely! https://ubccpd.ca/course/addiction-care-and-treatment
Metadol - In follow up to my email last week regarding supply of Metadol, I want to remind you that patients that have had a special authority request submitted or approved for Metadol-D® will be provided with coverage for both Metadol-D® and Metadol®. Metadol® and Metadol-D® are interchangeable products so a patient can use either as available. You DO NOT need to resubmit a special authority form at this time if one has already been submitted, however, forms can be submitted for NEW patients that are in need of this medication. Prescribers should be in direct contact with pharmacies that are dispensing Metadol® and Metadol-D® to ensure adequate supplies for current and new patients. As there is still limited supply these medications, you’re encouraged to carefully assess and discuss with your patients to ensure this is the appropriate treatment option at this time.
PharmaCare/PharmaNet Medical Practitioner Line - On January 8, 2019, a new service will be added to the PharmaCare/PharmaNet Medical Practitioner Line. Prescribers of OAT medications may use the Medical Practitioner Line to obtain a patient’s pharmacy name and contact information. This service will be accessible from the automated menu on the Medical Practitioner Line at 1-866-905-4912. Please note that this number is not intended for public use. Prescribers must have their relevant College ID number ready, in order to obtain access.
This service will be trialed for 3 months. If you have feedback on this service, please let PharmaCare know via email: [email protected] (specify “Medical Practitioner Line” in the subject line.)
Health Canada Exemptions - As you are aware, in September of 2018, Health Canada (HC) issued two exemptions to provide nurses with the authority to conduct specific activities with controlled substances while providing health care services at community health facilities under certain conditions. Since September, there have been a number of comments received from stakeholders. In light of those comments, HC has updated the exemptions on two occasions to do the following:
- To remove the reference to primary health care when referring to the health care services being offered in order to include settings such as treatment centres or addiction clinics; and
- To clarify that all nurses that are appropriately authorized by the laws of their province or territory to conduct activities are covered by the exemptions, not only those employed by the provincial or territorial government.
Withdrawal Management Bulletin - Just wanted to remind you that, as outlined in the provincial guidelines, withdrawal management alone is not an effective treatment for opioid use disorder, and offering this as a standalone option to patients is neither sufficient nor appropriate, due to the high risk of relapse and, thus, overdose. Care providers should clearly communicate to patients the risks of withdrawal management as a standalone strategy and encourage a period of opioid agonist therapy or a slower outpatient taper (e.g., > 3 months) with methadone or buprenorphine/naloxone. We have a great safety bulletin and patient consent form available on our website speaking to this, but attaching them here for your quick reference.
OAT Clinic Fee Coverage - Effective February 1st, 2019, patients with First Nations status are eligible to receive coverage for the private clinic fees associated with providing OAT to people in BC. The process is outlined clearly here: http://www.fnha.ca/what-we-do/mental-wellness-and-substance-use/opioid-agonist-therapy
Myth Busters – We’ve been hearing some misconceptions about Kadian pellets and absorption. If your patients are reporting pellets in their stool, reassure them that it’s normal and part of the design of this medication. As the pellets move through the GI track, the pH shifts allow for more and larger holes within the pellets to release the medication, while the core pellet itself remains largely intact and will be excreted in the stool as a normal part of this process. I’ve attached an interesting paper here for your perusal that goes into detail around some of these innovative opioid release medications.
National iOAT Guidelines – Earlier this fall, our team worked with a national committee to release a clinical and an operational guideline for injectable OAT. Check them out here: https://crism.ca/projects/ioat-guideline/
Methadone Formulations – I’ve been getting a number of questions about the differences between our provincial methadone formulations. To help, I’ve attached a handy little table for you that goes through some nuts and bolts of these medications (thanks to Mona Kwong!). Just a note that we are having this designed and embedded into POATSP so I’ll send you a nice version of this in the coming weeks that you can print for your clinic. We have also created a webinar presented by Dr. Christy Sutherland, Dr. Mona Kwong, and Garth Mullins to review our provincial methadone formulation options, the history, and important clinical details. Check it out here: https://youtu.be/baiUBbJC1M4
Release of the AUD guideline – The new Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder will help fill a crucial gap in the province’s addictions system of care and will allow people who are dealing with high-risk drinking or alcohol use disorder to be connected to services faster. The guideline aims to bridge the significant research-to-practice gap in this field, which will, in turn, improve access to evidence-based treatment for patients and families, and reduce the significant harms associated with alcohol use in British Columbia. The guideline includes recommendations to improve early screening and intervention in primary care, new tools for withdrawal management, and guidance for continuing care. They will be used by clinicians to manage and treat high-risk drinking and alcohol use disorder and will allow for earlier diagnosis and faster connection to the services people need. In addition, the BCCSU is working on two supplements to the guideline: one in partnership with the First Nations Health Authority, which will give clinicians the tools to provide culturally safe care to Indigenous peoples; and a second to support the management of alcohol use disorder during pregnancy. Check them out here: https://www.bccsu.ca/wp-content/uploads/2019/12/AUD-Guideline.pdf
Methadone Formulations – As of today, a third methadone option (made by Sterinova) is available as a regular PharmaCare benefit in BC. Sandoz Methadone (Sterinova) is cherry-flavoured and uses blue dye, which may be beneficial for patients who have experienced an adverse reaction to the red dye in Methadose. I’ll send you all a guidance bulletin in the new year on this but just wanted you all to be aware of this new option available in the meantime. I’ll also send along a new version of that methadone table (sent previously) which will include this new option.
Kadian Supply – the supply of Kadian has now been fully resolved and you should have no issues accessing this medication for your patients. Please let me know if you are experiencing any kind of on-going supply issues.
Or email [email protected]
Online SOWS - Colleagues of ours shared an online tool they made for patients to score SOWS (thanks to Nathan How and Dr. Ramm Hering). You are welcome to share this with your patients as well: http://sows.netne.net/
Nurses and Controlled Substances: Health Canada issued two s56(1) exemptions on September 5, 2018 to authorize nurses to possess, provide, administer, transport, send and deliver controlled substances while providing health care services at community health facilities under certain conditions. The exemption also allows nurses working at community health facilities to transport and provide controlled substances, prescribed by a practitioner, to the patient. Here are the links if you want to explore these more:
Addiction Care and Treatment Online Certificate - The Online Addiction Medicine Diploma Program is being redesigned and updated to bring you a more interactive and seamless learning experience. The new program is called the Addiction Care and Treatment Online Certificate and will be launched in January 2019. While you can still register for the old diploma program, we would highly recommend waiting until January to register for our brand new program, which will include nursing-specific modules. I will send you all the link to share with your colleagues as soon as that launches in January! Just a reminder that this course is free and includes content for opioids, alcohol, tobacco, stimulants, and cannabis.
Nasal Naloxone - Just a reminder that as of April 2018, First Nations Health Benefits (FNHB) accepts claims for naloxone for First Nations patients when initiated by a pharmacist or prescribed by physicians or nurse practitioners. FNHB provides coverage for naloxone kits and the nasal spray for naloxone, Narcan Nasal Spray, under the Non-Insured Health Benefits program (patients enrolled in Plan W). We have heard some confusion around this over the past couple weeks and wanted to ensure you all heard the same message from the BCCSU.
ED Suboxone Induction Protocol - Our ED working group has put together a draft of an ED induction protocol for Suboxone and we are looking to receive some feedback/review on this throughout the province. If you are interested, shoot me a quick message and we would love to have your thoughts on this.