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 prescribing opioid agonist treatments, which includes buprenorphine/naloxone, methadone, slow-release oral morphine, and injectable opioid agonist treatments (hydromorphone and diacetylmorphine).

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 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 will remain the same.

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.

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 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.

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

  • Full oral opioid agonist treatment CME – 8-10 hours
  • Buprenorphine/naloxone CME – 5-7 hours
  • Injectable Opioid Agonist Treatment CME – 2 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
  • Injectable Opioid Agonist Treatment (iOAT)

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, iOAT, 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. 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 methadone, buprenorphine/naloxone, sustained release oral morphine, and injectable opioid agonist treatment prescription
  5. Safely induce and maintain a patient on methadone, buprenorphine/naloxone, sustained 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 the acute care setting
  11. Manage precipitated withdrawal

EDUCATION REQUIREMENTS

The below requirements apply to both physicians and nurse practitioners who prescribe OAT.

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. With the standards, limits and conditions now fully in effect, it’s important to note the specific educational requirements and process to be able to prescribe these medications.

Oral Opioid Agonist Treatment Training

The process to meet the requirement for full oral OAT prescribing involves:

  • 8-10 hour online course (which includes both MainPro+ and MOC CME credits)
  • Completion of a workbook with clinical cases
  • 2 half-days of in-person preceptorship and any additional learning as needed

Injectable Opioid Agonist Treatment (iOAT)

Before prescribing iOAT, all prescribers are required to complete the oral opioid agonist treatment education and training as outlined above. The following are the education and training requirements to prescribe iOAT:

  1. Complete the iOAT training stream (2 hours) in the POATSP
  2. Submit the Preceptorship Form to the BCCSU
  3. Complete 1 half-day with an iOAT preceptor, the supplemental iOAT workbook, and any additional training as per the discretion of the preceptor
  4. The BCCSU will provide a copy of the Collaborative Prescribing Agreement to be signed and sent to the BC Ministry of Health

Important Note: All clinicians who wish to prescribe iOAT for opioid use disorder will need to complete a Collaborative Prescribing Agreement (CPA) that will be jointly signed by the BCCSU and prescriber and subsequently sent to the Ministry of Health for activation in PharmaNet. Any questions on this process can be sent to Amanda Giesler at agiesler@cfenet.ubc.ca.

Buprenorphine/Naloxone (Required for Nurse Practitioners Only)

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 the Provincial Opioid Addiction Treatment Support Program
  2. Complete the buprenorphine/naloxone stream (4 hours)
  3. Submit the Preceptorship Form to the BCCSU
  4. Complete 2 half-days of preceptorship, complete the relevant workbook cases (see Figure 1 for details) and additional learning as per the discretion of the preceptor

Upon successful completion of the above requirements, a signed proof of completion letter will be sent to the respective nurse practitioner. NPs should refer to CRNBC’s Scope of Practice document for additional information on standards, limits and conditions from the regulator.

PRECEPTORSHIP GOALS AND PROCESS

The goal of the BCCSU preceptorship program 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 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 provider to prescribe opioid agonist treatment in BC. 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.

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 bccsu_education@cfenet.ubc.ca.

FAQ's

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.

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.

Copyright © 2016, British Columbia Centre on Substance Use

400-1045 Howe St, Vancouver, BC V6Z 2A9

E: inquiries@bccsu.ubc.ca | T: (778) 945-7616 | F: (604) 428-5183

Online Addiction Medicine Diploma: bccsu_education@bccsu.ubc.ca.