×NEW from the BCCSU: As part of the provincial LOUD in the ED initiative that is co-led by the BCCSU, BC Patient Safety and Quality Council, and Ministry of Mental Health and Addictions, POATSP now offers 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. Click below to register.

OVERVIEW

In June of 2017, the British Columbia Centre on Substance Use (BCCSU) became responsible for the education and training pathways and clinical care guidance for prescribers of opioid use disorder treatment in BC. Amidst a provincial overdose crisis, British Columbia made concerted efforts to address gaps in the provision of evidence-based treatment options and care for individuals with opioid use disorder, including the development of provincial guidelines (BCCSU/MoH Guidelines for the Clinical Management of Opioid Use Disorder)as well as the creation of its aligned training program, the Provincial Opioid Addiction Treatment Support Program. This comprehensive training program includes education and training for prescribing opioid agonist treatments, which includes buprenorphine/naloxone, methadone, slow-release oral morphine, and injectable opioid agonist treatments (hydromorphone and diacetylmorphine). A detailed review of the program successes and updates can be found here.

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 education pathway that includes an online learning platform, clinical workbooks for prescribing practice, and in-person preceptorships. The online course is free and available for anyone to register – not just those seeking to prescribe opioid agonist treatments. The Health Canada requirement for practitioners to obtain an exemption under subsection 56(1) of the Controlled Drugs and Substances Act (CDSA) to prescribe and administer methadone no longer exists effective May 19, 2018, however, the education and training requirements for British Columbia are still in effect.

In BC, the approach to monitoring, prevention, and intervention related to pharmaceutical opioid-associated harms has been collaborative and multi-sectoral. The College of Pharmacists, the College of Physicians and Surgeons, and the College of Registered Nurses of BC provide essential regulatory functions for maintaining a coordinated response to prevent against, identify early and respond to prescription opioid-related harms.

While the BCCSU is mandated to provide the OAT education, training and clinical care guidance for prescribers, the Colleges will continue to regulate health professionals to ensure patient safety is not compromised (i.e. unsafe prescribing practices).

WHO SHOULD TAKE THIS COURSE?

The online training for the Provincial Opioid Addiction Treatment Support Program is geared towards opioid agonist treatment prescribers, including physicians, nurse practitioners, and nurses (RN/RPN). However, all health care providers (e.g., pharmacists, social worker, counsellors, etc.) can benefit from the online education modules. This program includes both MainPro+ and MOC accreditation per UBC CPD standards.

Current streams available in POATSP:

  • Oral Opioid Agonist Treatment in Community Settings – 8-10 hours
  • Oral Opioid Agonist Treatment in Acute Care Settings – 5-6 hours
  • Buprenorphine/naloxone ONLY CME – 4-5 hours
  • Injectable Opioid Agonist Treatment – 2 hours

On June 16, 2017, the College of Registered Nurses of British Columbia (CRNBC) approved new Nurse Practitioner Standards, Limits and Conditions that set out the requirements for both induction (initiation) and continuation/maintenance prescribing of opioid agonist treatment for opioid use disorder.

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
  • Pharmacotherapy, safety, and continuing care of opioid agonist treatment including buprenorphine/naloxone, methadone, slow-release oral morphine, and injectable treatment
  • Rural considerations
  • Home inductions
  • Polysubstance use
  • Strategies to prevent diversion
  • Youth and pregnant patients with opioid use disorder
  • Managing precipitated withdrawal - buprenorphine/naloxone
  • Treating opioid use disorder in acute care settings
  • Transitioning between opioid agonist treatment options

PROGRAM OUTCOMES

Provide a primarily online-based education curriculum to train prescribers 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 and prescribing goals pertaining to methadone, buprenorphine/naloxone, SROM and iOAT.

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

  1. Define and establish a diagnosis of opioid use disorder
  2. Evaluate a patient with opioid use disorder and create a patient-centred care plan
  3. Provide safe treatment of opioid use disorder with buprenorphine/naloxone, methadone, slow-release oral morphine, and injectable opioid agonist treatment
  4. Write a safe and clear prescriptions for methadone, buprenorphine/naloxone, slow-release oral morphine, and injectable opioid agonist treatment
  5. Safely induce and maintain a patient on methadone, buprenorphine/naloxone, slow-release oral morphine, and injectable opioid agonist treatment
  6. Engage a patient in comprehensive and continuing care
  7. Provide trauma-informed care to people with opioid use disorder
  8. Educate patients about harm reduction and integrate harm reduction provision into clinical care
  9. Transition patients between modalities of pharmacotherapy for opioid use disorder
  10. Provide opioid agonist treatment to patients in acute care settings
  11. Manage precipitated withdrawal

EDUCATION REQUIREMENTS

Oral Opioid Agonist Treatment Training – Physicians and Nurse Practitioners in Community Settings

The process to meet the provincial requirements for oral OAT prescribing:

  1. Complete the Oral OAT Community Setting course stream in POATSP
  2. • This takes 8–10 hours, which includes both MainPro+ and MOC CME credits
  3. Complete the Community Setting Workbook
  4. • This contains clinical cases and prescription practice
  5. Complete the Preceptorship Form and submit to the BCCSU
  6. Attend two half-days of in-person Preceptorship and any additional learning at the discretion of the preceptor

Once these steps are completed, the provider is then issued with a Proof of Completion letter upon evaluation sign-off.

Oral Opioid Agonist Treatment - Physicians and Nurse Practitioners in Acute Care Settings

The process to meet the provincial requirements for oral OAT prescribing:

  1. Complete the Oral OAT Acute Care Settings course stream in POATSP
  2. • This takes 5–6 hours, which includes both MainPro+ and MOC CME credits
  3. Complete the Hospitalist’s Workbook
  4. • This contains clinical cases and prescription practice
  5. Complete the Preceptorship Form and submit to the BCCSU
  6. Attend two half-days of in-person Preceptorship and any additional learning at the discretion of the preceptor

Once these steps are completed, the provider is then issued with a Proof of Completion letter upon evaluation sign-off.

Important Notes

  • The Certificate of Completion is issued once learners complete the required modules within a course stream.
  • Once this certificate is issued, relevant workbooks, online preceptorship forms, and preceptor contact lists are provided in the certificate of completion section.

Oral Opioid Agonist Treatment – Nurses (RN’s or RPN’s)

The scope of practice for registered nurses and registered psychiatric nurses now includes prescribing buprenorphine/naloxone, with the potential for expanded medication options in 2021. RNs and RPNs looking to complete the required education and training pathway through the BCCSU must seek formal authorization from their organization (e.g., from supervisors and organizational leaders). Please direct any additional questions you may have to [email protected].

The specific educational requirements for prescribing buprenorphine/naloxone can be found on this page down below.

Buprenorphine/naloxone ONLY - Physicians

Physicians only prescribing buprenorphine/naloxone are encouraged to complete the General Learner course stream in POATSP. Physicians do not need to complete the workbooks or preceptorship components. All steps listed above are the provincial requirements for prescribing the full continuum of oral OAT options.

Buprenorphine/naloxone ONLY – Nurse Practitioners

Nurse practitioners who only prescribe buprenorphine/naloxone for the treatment of opioid use disorder must complete the following requirements:

  1. Register as a General Learner in POATSP
  2. Complete the General Learner course stream in POATSP
  3. • This takes 4 hours
  4. Complete the Community Setting Workbook
  5. • This contains clinical cases and prescription practice
  6. Complete the Preceptorship Form and submit to the BCCSU
  7. Attend two half-days of in-person Preceptorship and any additional learning at the discretion of the preceptor

Buprenorphine/naloxone ONLY – Nurses (RN’s or RPN’s)

The BCCSU education and training requirements for RN/RPN prescribing of buprenorphine/ naloxone in British Columbia includes the following:

  1. Complete the required modules in the online POATSP course stream for RNs/RPNs (12–14 hours)*
  2. Complete the Nurse Prescribing Workbook
  3. Submit the Preceptorship Form to the BCCSU
  4. Attend four half-days (or two full days) of in-person preceptorship and any additional learning at the discretion of the preceptor
  5. Preceptor to sign off on Preceptor Review Form sent through email

Once these steps are completed, the nursing professional is issued a BCCSU Proof of Completion letter. This will also be sent to the BC College of Nurses and Midwives (BCCNM) to process prescriber numbers and prescription pads.

* If you have previously registered and completed POATSP course material before February 2021, please ensure you re-register as an RN/RPN, as your course stream will be updated and customized to this new required education and training pathway.

RNs and RPNs looking to complete the required education and training pathway through the BCCSU must seek formal authorization from their organization (e.g., from supervisors and organizational leaders). Please direct any additional questions you may have to [email protected].

Injectable Opioid Agonist Treatment Training – Physicians and Nurse Practitioners

Prerequisites:

  1. Complete the oral OAT training

The education and training requirements to prescribe iOAT:

  1. Complete the iOAT course stream in POATSP
  2. • This takes 2 hours
  3. Complete the iOAT Workbook
  4. • This contains clinical cases and prescription practice
  5. Complete the Preceptorship Form and submit to the BCCSU
  6. Complete one half-day Preceptorship and any additional training at the discretion of the preceptor

Once these requirements have been met, the BCCSU will provide a copy of the Collaborative Prescribing Agreement to be completed. The form will be jointly signed by the BCCSU and prescriber and subsequently sent to the BC Ministry of Health for activation in PharmaNet. Contact [email protected] for any questions on this process.

Urgent Circumstances

There may be instances where prescribers have not yet completed their provincial requirements to prescribe opioid agonist treatments, but an urgent situation requires either maintenance or initiation of these medications. In these one-off circumstances, prescribers may consult either the RACE Line or the 24/7 Addiction Medicine Clinician Support Line for guidance in these circumstances and chart their process and decision making diligently.

PRECEPTORSHIP GOALS AND PROCESS

The goal of the POATSP preceptorship components is to promote understanding and application of the provincial Guideline for the Clinical Management of Opioid Use Disorder in a supervised clinical setting. In order to complete the preceptorship requirement:

  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 the appropriate workbook (see "Preceptee Resources" here) before the scheduled preceptorship. The workbook will be reviewed together with the preceptor.
  3. Preceptors are responsible for completing a review of the workbook, ensuring the diversion agreement is discussed and signed, and providing an assessment and sign-off of the preceptees, based on competencies demonstrated and articulated in person.

Renewal Process

In consultation with our POATSP Steering Committee, the BCCSU has decided to move forward with a simple renewal process. Once prescribers have received a signed proof of completion letter (upon meeting all education requirements listed above), prescribers may continue prescribing in perpetuity, barring direct follow up from relevant colleges (i.e. disciplinary action). There are no further educational or administrative requirements as this letter does not expire. In order to continue supporting practice with education and clinical care guidance, the BCCSU will send all trained prescribers an annual summary of education, guidance, research, and other important information that are deemed crucial for continuing medical education. All trained prescribers will also be included in the BCCSU prescriber network, that facilitates access to monthly “Prescriber Blasts” with the real-time, system-level changes that affects prescribers and patients in the British Columbia.

Clinical Care Guidelines

All opioid agonist treatment prescribers should read and align their clinical practice to the following guidelines and support tools when practicing in the province of British Columbia:

Additional Information

For broad BCCSU education & training questions and/or feedback, please contact [email protected].

FAQ's

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

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.

The Health Canada requirement for practitioners to obtain an exemption under subsection 56(1) of the Controlled Drugs and Substances Act (CDSA) to prescribe and administer methadone has been removed, effective May 19, 2018. The Canadian Research Initiative in Substance Misuse (CRISM) conducted a broad consultation on the section 56 exemption requirement, and stakeholders indicated that removing the requirement would “normalize” methadone treatment and help reduce the stigma associated with treatment for substance use disorders. It is important to note that while the Health Canada exemption processing will no longer exist after this date, the education and training requirements for British Columbia will remain the same.
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Online Addiction Medicine Diploma: [email protected].