The opioid crisis is gripping the province of B.C. even more tightly during the COVID-19 pandemic. In 2020 alone, 1,716 people died due to illegal drug overdose—a 74 per cent increase over 2019. In response, B.C.’s provincial health officer issued a public health order that made B.C. the first province in Canada to allow nurses to prescribe life-saving opioid agonist treatment (OAT) for people living with an opioid use disorder.
Under the new order, both registered nurses and registered psychiatric nurses in B.C. can prescribe Suboxone, one of a handful of OAT medications that effectively treat opioid addiction by managing withdrawal symptoms, reducing cravings for opioids and decreasing substance-related harms. Other common medications used for OAT include methadone and Kadian.
The initiative couldn’t have come sooner for Jessica Martens, a registered psychiatric nurse who works with the Nanaimo Forensic Regional Clinic at BC Mental Health and Substance Use Services, which provides mental and substance use services to clients who are in conflict with the law. With calls for help mounting, she felt an urge to step forward.
“When I first heard about Dr. Henry doing this initiative, I said to myself, ‘I’m going to do this.’ Later, when my regional manager emailed out looking for interest in the nurse prescriber program, I don’t think it even hit every nurse between the Nanaimo and Victoria clinics before I responded in big capital letters, ‘ME PLEASE!’” says Martens.
Martens was part of the first group of 30 nurses across the province who completed rigorous training on addictions medicine through the BC Centre on Substance Use earlier this year. Now, 10 of our forensic clinic nurses have joined the teams of physicians, nurse practitioners and pharmacists who are already prescribing opioid agonist treatment to our clients.
“This initiative represents yet another step toward addressing the ongoing opioid crisis,” says Angus Monaghan, the director of the Forensic Regional Community Clinics. “It is absolutely essential to have timely access to care and treatment. Nurse prescribers will help eliminate access delays and give clients access to the medications they need until they can see an addictions physician.”
"Bringing nurses in to provide additional support means shorter wait times to see addictions physicians, immediate access to Suboxone, education, Naloxone training, including kits, and harm reduction support."
Expanding access to addiction treatment medications means fewer clients visitsing emergency department or landing in the correctional system. For Martens, the key is supporting the client at the first point of contact, which improves their chances of getting the right treatment at the right time.
“When someone is ready to make a change in their life, like starting on Suboxone, they shouldn’t have to wait days or weeks to see someone,” she says. “Bringing nurses in to provide additional support means shorter wait times to see addictions physicians, immediate access to Suboxone, education, Naloxone training, including kits, and harm reduction support. Providing access to Suboxone means we’re also saving several people’s lives.”
“Through this team-based, client-centred care approach, we can catch clients as soon as they’re ready and help provide a pathway to recovery where every door is the right door.”
Nurse prescribers also help play an important role in improving coordination and continuity of care, says Terri-Lee Seeley, the director of interprofessional practice for Correctional Health Services and Forensic Regional Clinics, who led the initiative on behalf of BC Mental Health and Substance Use Services.
“Through this team-based, client-centred care approach, we can catch clients as soon as they’re ready and help provide a pathway to recovery where every door is the right door,” says Seeley.
July 2 is a day Martens vividly remembers—she wrote her first prescription that day, and has continued to support one of her clients with five additional prescriptions for Suboxone since.
"It was a really positive experience to see team members from different disciplines come together and deliver this ground-breaking project."
“Clients are surprised when I bring up that I can prescribe Suboxone for them if that is something they want to pursue. They like that they don’t have to go to multiple clinics in order to get prescriptions or see multiple health care professionals,” she says.
Nancy Desrosiers, the provincial executive director of Correctional Health Services and Forensic Regional Clinics, recognizes all the hard work involved in meeting the conditions of the public health order.
“A team of experts tackled a number of important tasks to ready the clinics for implementation. I’m thankful for Terri-Lee, the policy team and all other support team members who pulled this off in record time,” she says. “It was a really positive experience to see team members from different disciplines come together and deliver this ground-breaking project.”
Monaghan acknowledges there is much more to do to curb the opioid epidemic, but sees this initiative as an important step toward enhancing B.C’s response.
“Success is the complete elimination of toxic deaths due to opioids. Until then, all efforts to reduce the potential of death needs to be undertaken. This initiative is an important step.”