Registrants are reminded that, regardless of specialty or discipline, substance use disorder (SUD) and the risk of overdose may be present in any patient, not only those with an opioid use disorder or another diagnosed SUD. The ability to recognize and manage patients with SUD, or those at risk of overdose, is a core competency for all registrants and should be part of lifelong learning. For registrants providing more specialized care, additional training requirements apply.
Education and guidance
Educational opportunities are available through the (BCCSU), with offerings tailored to different scopes of practice, including primary care, internal medicine, psychiatry, and related specialties.
CPSBC’s requirements and recommended education on SUD, opioid agonist treatment (OAT), and prescribed safer supply (PSS) are available on CPSBC’s Management of Substance Use Disorder section of its website. Registrants are encouraged to review this resource regularly and refer to it if unsure of their obligations. The website provides guidance for the following areas:
Opioid agonist treatment (OAT)
Registrants prescribing OAT must complete training through the Provincial Opioid Addiction Treatment Support Program (POATSP).
- Full agonists (e.g. methadone, slow-release oral morphine): Extra training is mandatory.
- Partial agonists (e.g. Suboxone, buprenorphine/naloxone): Extra training is not required, but is strongly encouraged.
All family physicians can prescribe Suboxone and may be asked to continue prescribing for stable patients co-managed with addiction physicians. Guidance on induction and initiation protocols is available through the BCCSU.
Prescribed safer supply (PSS)
Registrants providing safer supply medications (e.g. hydromorphone, fentanyl) are encouraged to pursue additional training in substance use management (such as POATSP). This helps support a comprehensive approach 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.
A reminder: Prescriptions for PSS must include “SA” (safer alternative) in the “direction for use” section of the duplicate prescription pad. This notation is important for monitoring the safety and effectiveness of PSS.
Outpatient vs. hospital settings
CPSBC’s requirements apply to prescribing in outpatient settings. Health authority policies govern how medications are ordered in hospitals and take precedence, particularly for methadone for pain and opioid agonist treatment. Hospitals and other health authority facilities may have more, or less, expectations and requirements than those listed here for outpatient prescribing with respect to ordering medications, and the oversight and administration of these medications. Registrants are expected to know and follow local hospital policies, and to work collaboratively and respectfully with health care teams to support the best outcomes for patients.
CPSBC resources