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Prescribing for opioid use disorder


Prescribing for opioid use disorder

The Provincial Health Officer (PHO) in September 2020 issued an order temporarily authorizing RNs and RPNs to diagnose and treat a problem substance use condition or substance use disorder, as part of its response to the overdose crisis public health emergency.

BCCNM in September 2020 introduced a new prescribing standard for RNs and RPNs. At the same time, the board also approved RN and RPN scope of practice limits and conditions for prescribing buprenorphine/naloxone to treat opioid use disorder.

The following BCCNM standards set foundational requirements, including limits and conditions, for RN and RPN prescribing for opioid use disorder:

Note: while the public health order allows RNs and RPNs to prescribe to treat opioid use disorder, it does not allow RNs or RPNs to give a client-specific order for another nurse to administer or dispense drugs to treat opioid use disorder.

FAQs

What do I need to do to be able to prescribe for opioid use disorder (OUD)?

You can begin prescribing once you have met all the following criteria:

  • Your organization/employer recognizes you as a prescriber

  • You successfully complete additional education and the preceptorship requirements  established by the B.C. Centre on Substance Use (BCCSU)

  • Your organization/employer has policies, processes and resource in place to support RN prescribing

  • BCCNM has provided you with a prescriber ID

  • You participate in the B.C. Controlled Prescription Pro​gram (CPP) and obtain the duplicate prescription pads required to prescribe for opioid use disorder. Nurses who meet the conditions should log into their BCCNM account to order CPP pads.

  • You obtain a Medical  Services Plan (MSP) number allowing you to order diagnostic tests specific to prescribing for opiod use disorder

  • You obtain Pharmanet access

  • You are in good standing with BCCNM

Other than NPs, which nursing designations are authorized to prescribe for OUD?

RNs or RPNs who:

  • Are recognized by their organization/employer to prescribe for OUD
  • Successfully meet the BCCNM limits and conditions for prescribing for OUD

As per regulations, LPNs are not authorized to prescribe medications.

As an OUD nurse prescriber, what medications can I prescribe within my autonomous scope of practice?

Once they meet the BCCNM standards, limits and conditions for prescribing for OUD, nurse prescribers are permitted to prescribe buprenorphine-naloxone, methadone, and slow-release oral morphine. 

OUD nurse prescribers can also prescribe some adjunct medications for symptom management when prescribing for the treatment of OUD, as per BCCSU guidelines and protocols and their organizational/employer policy and processes.

Nurses prescribing for OUD must be recognized by their organization as a nurse prescriber. They must also f​​ollow their organizational policies, which may vary from one organization to another.​

As an OUD nurse prescriber what is the prescribing standard requirement for client assessment?

In addition to the other requirements within the Prescribing standard, nurses can assess:

  • the client in person, or
  • through a virtual health care encounter with a visual assessment if clinically appropriate or;
  • without a visual assessment only after determining that it is clinically appropriate and only:

    i. if the client is known to the nurse, and/or
    ii. the client is being assessed in person by another health care provider

Consulting and referring

BCCNM has created a resource related to RN and RPN responsibilities and accountabilities when consulting with or referring to other health professionals when prescribing for opioid use disorder (OUD).

Resources