New BCCSU Provincial Guidelines and Professional Practice Policy Updates for Managing Opioid Use Disorder

New bccsu Provincial Guidelines and Professional Practice Policy Updates for Managing Opioid Use Disorder

[Updated on December 1, 2023]

On November 22, 2023, the British Columbia Centre on Substance Use (BCCSU) released updates to BC’s provincial Guideline for the Clinical Management of Opioid Use Disorder (OUD Guideline).

In order to align with the updated guidelines, at its November 2023 meeting, the College Board approved amendments to Professional Practice Policy 66: Opioid Agonist Treatment (PPP-66) and its accompanying policy guides.

Update to BC’s Guideline for the Clinical Management of Opioid Use Disorder

In 2017, the BCCSU took over responsibility from the College of Physicians and Surgeons of BC for providing guidance for prescribing medications to treat opioid use disorder. In doing so, they published a new provincial clinical practice guideline, introducing a pharmacy-based model for Opioid Agonist Treatment (OAT) and outlining pharmacists’ responsibilities for patient safety.

According to the BCCSU, evidence, best practices and clinical expertise related to the provision of care for opioid use disorder have evolved due to a more toxic drug supply and the COVID-19 pandemic. These changes led to a review and update of the OUD Guideline by the BCCSU. An expert committee of three co-chairs and 30 interdisciplinary members from around the province updated and developed 13 key recommendations to guide the treatment of opioid use disorder. 

The updated Guideline for the Clinical Management of Opioid Use Disorder ensures health care providers have access to updated recommendations and clinical guidance.

Key recommendations include shifting away from first/second/third-line treatments to collaborative decision-making based on clinical judgement and client goals, circumstances, and preferences and the inclusion of extended-release buprenorphine in the continuum of care. Other key updates include changes to OAT dosing, titration, missed dose, and take-home dosing protocols as well as the addition of principles of care meant to guide care for all people with opioid use disorder. These principles include trauma- and violence-informed care, cultural safety and humility, anti-racism, and person-centred care.

Updates to Professional Practice Policy 66: Opioid Agonist Treatment

To align with the clinical updates made to the OUD Guideline, the College Board approved amendments to Professional Practice Policy 66: Opioid Agonist Treatment (PPP-66) and its accompanying policy guides. These updates are now in effect. 

These amendments to PPP-66 and its accompanying policy guides were implemented on November 22, 2023 and reflect the following areas:

• Updated guidance on missed doses protocols in each policy guide; 
• Addition of a ‘last resort’ compounding exception to the methadone maintenance policy statements for patients who have not benefited from documented, reasonable trials of at least two commercially available methadone formulations, and for whom methadone remains the optimal OAT option or during a period of shortage or no supply of a commercially available methadone oral preparation;
• Removal of guidance for first/second/third-line treatment options in favour of collaborative decision-making based on clinical judgement and client goals, circumstances, and preferences;
• Updates requiring pharmacies providing MMT services to maintain the most recent version of the Health Canada Policy on Manufacturing and Compounding Drug Products (POL-0051) as a required pharmacy reference material. 

While the College is not responsible for the development and implementation of clinical practice guidelines, the College supports the provincial OAT program through the development of policies for OAT dispensing, such as PPP-66 and the accompanying guides, that align with provincial guidance to ensure safe standardized access to OAT. 

Learn more at:

bcpharmacists.org/OAT