Substance use disorders have had a profound impact on the health of British Columbians. The overdose crisis continues to rage in the province and there continues to be staggering statistics about the number of lives lost tragically because of the toxic illicit drug supply.
Registrants are reminded, regardless of specialty or discipline, that they need to be aware of the possibility of substance use disorder (SUD), or the risk of overdose in their patients. Not all patients who are at risk of overdose from the toxic drug supply will meet the criteria for opioid use disorder or another SUD. Being able to identify and manage patients with SUD or risk of overdose is a core competency of all registrants and should form part of their lifelong learning.
Registrants in primary care, internal medicine, psychiatry and related specialties may wish to undertake specialized training and establish added competencies in management of opioid use disorder (OUD). There are many educational offerings available at the that are tailored to different scopes of practice.
For registrants choosing to prescribe opioid agonist treatment (OAT) to their patients, training through the Provincial Opioid Addiction Treatment Support Program (POATSP) is required. For those choosing to prescribe full agonist OAT (methadone, slow-release oral morphine, etc.), extra training is mandatory.
While extra training is not mandatory for registrants who wish to prescribe partial agonist OAT (Suboxone, buprenorphine/naloxone), it is still strongly encouraged.
All family physicians can write prescriptions for Suboxone for their patients and are encouraged to assist addiction physicians co-managing their patients if the addiction physician requests that a stable patient continue being prescribed Suboxone.
Registrants wanting to learn about evidence-based guidance for initiating this medication and induction protocols can do so through the educational offerings of the BCCSU.
Registrants who are undertaking a harm reduction approach and providing patients with Prescribed Safer Supply (PSS) medications (hydromorphone, fentanyl, etc.), are strongly encouraged to undertake extra training in the management of substance use (POATSP, etc.) so they can provide “wrap around” substance use care to their patients, assist in transitioning these patients to optimal treatment regimens, and linking them to appropriate social supports when they are ready to do so.
PSS is a rapidly evolving medical strategy, and all registrants are encouraged to stay updated on practice guidelines set out by the BCCSU, and to adhere to protocols set out by health authority programs aimed at addressing SUD.
Registrants are reminded of the requirement to write “SA” (safer alternative) in the “direction for use” section of the controlled prescription form (duplicate form). This notation is crucial and will enable data to be derived on the safety and effectiveness of PSS.