Guest Post: New Provincial Training Programs Jul. 31, 2017 Guest Post, BC Centre on Substance Use, Opioid overdose crisis, Professional Development

Guest Post: New Provincial Training Programs – Provincial OAT Support Program and Online Addiction Medicine Diploma 

This is the third in a series of guest posts from the BC Centre on Substance Use (BCCSU). For an overview of the new provincial guideline for the treatment of opioid use disorder, potential impacts on your pharmacy practice and guidance for dispensing opioid agonist medications, please see previous posts on buprenorphine/naloxone and slow-release oral morphine.

New Online Educational and Training Resources Available 

The Provincial Opioid Addiction Treatment Support Program (POATSP) and Online Addiction Medicine Diploma are two separate online training programs developed by the BC Centre on Substance Use (BCCSU). The BCCSU’s mandate is to develop recommendations, resources, and training that will improve the care and treatment for patients and their families who are dealing with addiction and problematic substance use. Since its launch, the BCCSU has also developed and released a new Provincial Guideline for the Clinical Management of Opioid Use Disorder, which became effective June 5, 2017. 

Programs At-a-glance

The BCCSU’s Provincial Opioid Addiction Treatment Support Program (POATSP), launched in July 2017, encompasses the new provincial regulatory program for the treatment of opioid use disorder (incl. processing of methadone exemptions for prescribers in BC) in addition to a new interactive online learning platform for health providers involved in the treatment and care of individuals with opioid use disorder.  

The BCCSU’s Online Addiction Medicine Diploma, launched in May 2017, is a free online diploma course for all health care providers and members of the general public interested in receiving a broad overview of substance use disorders and care. 

Recommendations for continuing professional development 

All pharmacy managers, staff, relief pharmacists, and pharmacy technicians employed in a community pharmacy that provides methadone must have successfully completed the mandatory CPBC MMT training program, and have implemented all necessary practice requirements identified in the CPBC Methadone Maintenance Treatment Policy Guide (2013). You must log into E-Services to complete the Declaration of Completion and Understanding prior to providing MMT services. For more information on required MMT training please see http://www.bcpharmacists.org/methadone-maintenance-treatment-mmt and the College of Pharmacists of BC’s Professional Practice Policy (PPP-66) Methadone Maintenance Treatment.  

In addition to this required training, it is recommended that pharmacists who dispense opioid agonist medications and/or work with patient populations with substance use disorders remain up-to-date with knowledge of addiction treatment, guidelines, and medications through continuing professional development. 

Previously, pharmacists and other health care providers may have fulfilled this recommendation by completing the Methadone/Buprenorphine 101 Workshop, formerly offered through the College of Physicians and Surgeons of British Columbia. The Methadone/Buprenorphine 101 Workshop has been discontinued and replaced by the online training modules of the POATSP. If health care providers have completed the Methadone/Buprenorphine 101 Workshop prior to October 2016, it is recommended that they refresh their knowledge by completing relevant modules of the POATSP course, as provincial guidelines for the clinical management of opioid disorder have since been updated. 

Pharmacists in BC are eligible to receive both accredited and nonaccredited Continuing Education Units (CEU’s) toward the Professional Development and Assessment Program (PDAP) on completion of POATSP and Online Addiction Medicine Diploma modules. For more details on self-reporting and credit eligibility, please see the section on CEU’s for each program below. 

POATSP: New provincial regulatory program for opioid addiction treatment – Launched July 2017

The BCCSU’s Provincial Opioid Addiction Treatment Support Program (POATSP) has now replaced the provincial methadone program previously regulated by the College of Physicians and Surgeons of British Columbia (CPSBC) and has been expanded to include the full range of medications used to treat opioid addiction (i.e., methadone, buprenorphine/naloxone, and slow-release oral morphine). The POATSP program is also inclusive of online training modules that provide a walk-through of the BCCSU’s new clinical care guidance for opioid agonist prescribing (more details in the following section).

As part of this program, the BCCSU provides recommendations to Health Canada regarding exemption authorizations for physicians who wish to prescribe methadone for opioid use disorder. The BCCSU is working with the College of Registered Nurses of BC (CRNBC) to optimize the methadone exemption process for nurse practitioners (NPs), whose standards, limits and conditions to prescribe full OAT will take effect once operational processes (e.g., prescriber exemptions for methadone prescribing under Section 56 of the Controlled Drugs and Substances Act) and quality assurance processes are in place.

However, as part of its regulatory function, the CPSBC will continue their Prescription Review Program in accordance with the core principles for safe and effective prescribing practices as per the CPSBC Guidelines and Standards for the Safe Prescribing of Drugs with Potential Misuse/Diversion. The CPSBC will also continue to provide support for physicians prescribing methadone for analgesia. Additionally, the exemption process for prescribers of methadone for analgesia will remain the responsibility of the College of Physicians and Surgeons of BC.

POATSP: Online training modules 

In order to improve access and provincial capacity for opioid agonist treatment education for health professionals, the BCCSU is transitioning to an online learning environment, and has developed a new interactive online learning platform in collaboration with the UBC Faculty of Medicine’s Continuing Professional Development (CPD). The course articulates the BCCSU’s new clinical care guidance for opioid agonist prescribing through interactive content, videos, and case studies. While the comprehensive course is geared primarily towards opioid agonist treatment prescribers, all health care providers involved in addiction care (e.g., nurses, pharmacists, social workers, counsellors, etc.) can benefit from the online education modules. 

Relevant modules for pharmacists may include, but are not limited to: 1) Overview of Opioid Use Disorder; 5) Harm Reduction; 7-9) Methadone - Pharmacotherapy, Safety, and How to Write a Prescription; 10-11 and 16) Buprenorphine/Naloxone - Pharmacotherapy, Induction, and How to Write a Prescription; 13) OAT Continuing Care; 17) Slow-Release Oral Morphine (SROM); 18) Polysubstance Use While on Opioid Agonist Treatment;19) Comparing Methadone and Buprenorphine/Naloxone; and 21) Strategies to Prevent Diversion 

POATSP: Credit for continuing education (CEU’s)

Pharmacists in BC are eligible to receive up to 8 Mainpro+ credits on successful completion of the online modules. To earn accredited CEU’s toward the Professional Development and Assessment Program (PDAP)’s annual renewal requirements, you are required to complete the following modules in order to receive a certificate of completion: 1-6 and 7-9 or 10-12 and 13-21. If not seeking accredited CEU’s, you may simply select modules of relevance to your practice, self-track the hours spent on these modules, and claim these hours as unaccredited CEU’s. To receive credit for PDAP, you must self-report this activity by entering the credit hours you have completed into your Learning Record using the online CE-Plus tool and indicating whether these hours are accredited or non-accredited. 

Important changes to methadone exemptions for physicians prescribing methadone 

Exemptions for community prescribers:

• Only prescribers with full methadone exemptions for opioid use disorder may perform inductions (i.e. initiate methadone prescriptions) and alter a patient’s dose.  
• Prescribers with a temporary methadone exemption for opioid use disorder may provide maintenance only (i.e., inductions cannot be given) and cannot alter a patient’s dose. 
• Note: under a temporary exemption for methadone for pain, dose alterations are permitted but inductions cannot be given.

Hospitalist prescribers no longer require temporary exemptions to prescribe methadone for opioid use disorder.

When submitting a prescription from a prescriber who is not authorized to prescribe methadone (i.e., the issuing prescriber does not hold a valid and current exemption for methadone for opioid use disorder), an error message will appear on PharmaNet preventing the prescription from being processed. If this occurs, please contact the prescriber who issued the prescription.

Are prescribers required to hold an exemption for buprenorphine/naloxone (Suboxone®)?

• At this time, physicians and nurse practitioners (NPs) do not require an exemption to prescribe buprenorphine/naloxone. 
• Currently, nurse practitioners (NPs) who meet the regulatory requirements for NP prescribing of controlled drugs and substances in BC must follow the standards, limits and conditions for the continuation of buprenorphine/naloxone for the treatment of opioid use disorder.
• Note: the scope of NP prescribing of opioid agonist treatment in BC is in the process of being expanded to include initiation of buprenorphine/naloxone and continuation and initiation of methadone. 

Are prescribers required to hold an exemption for slow-release oral morphine (Kadian®)?

• At this time, physicians do not require an exemption to prescribe slow-release oral morphine, although it is strongly recommended that they hold a valid federal Section 56 exemption and seek specialist consultation to prescribe this medication.

Online Addiction Medicine Diploma – Launched May 2017

The Online Addiction Medicine Diploma, created in partnership with the Province of British Columbia, the Ministry of Health, and the UBC Faculty of Medicine, is a free online diploma course for health care providers and members of the general public interested in receiving a broad overview of substance use disorders (incl. alcohol, tobacco, opioid, and stimulant use) and caring for patients with substance use and addiction. 

Course topics include screening and diagnosing, safe prescribing, overdose prevention and harm reduction, recovery-oriented care, and treating withdrawal. The modules are led by expert clinicians, educators, and researchers from across the province.

Online Addiction Medicine Diploma: Credit for continuing education (CEU’s)

Pharmacists in BC are eligible to receive up to 16 UBC CPD-accredited Mainpro+ credits on successful completion of the online diploma. Anyone can register and complete as many modules as they wish. However, to obtain the diploma and claim accredited CEU’s toward PDAP, completion of all modules is required. If not seeking accredited CEU’s, you may simply select modules of interest, self-track the hours spent on these modules, and claim these hours as unaccredited CEU’s. To receive credit for PDAP, you must self-report this activity by entering the credit hours you have completed into your Learning Record using the online CE-Plus tool and indicating whether these hours are accredited or non-accredited.

The authors would like to acknowledge the following individuals/groups for their review of this article: Nadia Mallay, Education Lead, BC Centre on Substance Use; Christy Sutherland, Education Physician Lead, BC Centre on Substance Use; College of Pharmacists of BC; College of Registered Nurses of BC; and the BC Ministry of Health.  

For more information and program resources, please visit www.bccsu.ca. 

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Jessica Jun 

Jessica is a Student Research Assistant with the BC Centre on Substance Use (BCCSU) and a B.Sc. candidate in Integrated Sciences at the University of British Columbia. Her research interests include factors in adherence to antiretroviral therapy for individuals with HIV, and innovation in the treatment of opioid use disorder in correctional settings. In her role at the BCCSU, Jessica additionally works with the BC Node of the Canadian Research Initiative in Substance Misuse (CRISM) on clinical trial and community based research in partnership with drug user groups in Vancouver’s Downtown Eastside. Previously, she has worked with Dr. Julie Robillard at the National Core for Neuroethics on validation of a resource to help users navigate e-health information.

Cheyenne Johnson, MPH, RN, CCRP

Cheyenne Johnson is the Director of Clinical Activities and Development with the BC Centre on Substance Use and the Director of the BC Center on Substance Use Addiction Nursing Fellowship. In her current position she oversees the development of provincial clinical care guidance documents and dissemination, including evidence-based clinical guidelines, practice support tools and policy briefs.

Cheyenne completed her Bachelor of Nursing Science at Queen’s University and her Master’s of Public Health at Simon Fraser University. She joined the BC Centre for Excellence in HIV/AIDS in 2013 as a Clinical Research Nurse, where she went on to be the Inaugural Nursing Fellow of Canada’s only adiction nursing training program, the St. Paul’s Goldcorp Addiction Nursing Fellowship.

Amanda Giesler, MHA 

Amanda Giesler is a Project Coordinator focusing on implementation with the BC Centre on Substance Use (BCCSU). She currently manages simultaneous implementations of clinically focused care guidance and educational projects that are provincial in scope. Amanda holds a Master’s of Health Administration from the University of British Columbia and worked previously in the technology industry and on a research project at St. Paul’s Hospital facilitating research that aimed to expand the reach of take-home naloxone programs.