Management of substance use disorder

The College expects registrants, regardless of specialty or discipline, to be aware of the possibility of substance use disorder (SUD) or the risk of overdose in their patients. 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.

Prescribed safer supply

A public health emergency

In 2016, a public health emergency related to opioid overdose deaths was declared by the provincial health officer. Currently six people per day are dying of drug overdoses, which are most often linked to fentanyl in the illicit drug supply. The College acknowledges with sadness the devastating toll that illicit drug toxicity has had on members of our communities, and their families and friends.

Government action

The BC Ministry of Health (MoH) and Ministry of Mental Health and Addiction (MMHA) have taken bold action to encourage prescribing of safer pharmaceutical alternatives/prescribed safer supply to combat this crisis.

In July of 2021, they published Access to Prescribed Safer Supply in British Columbia: Policy Direction. Each health authority was directed to enhance or establish programs to support prescribing hydromorphone products, fentanyl products, and other pharmaceutical products as a safer alternative to the toxic street supply.

Providing pharmaceutical-grade alternatives to the toxic street supply, both in the context of a comprehensive treatment plan or as a standalone harm reduction strategy, may allow registrants to better support patients with substance use disorder, and may reduce their risk of overdose and death.

Role of the regulator

The College’s role is to ensure registrants provide safe care to their patients. It has no role in advocating for or endorsing any particular clinical intervention or settling the scientific debate on the risks and benefits of safer supply. The College defers to experts in this field who are working together to gather more evidence to inform clinical guidelines and program developments.

The College strongly supports sound scientific research and data collection that will define best practices, and guide improvements to health-care programs.

Prescribing safer supply and training

Registrants interested in learning more about SUD and safer supply can engage with their health authority or the BC Centre for Substance Use to find out which programs and training are available in their jurisdiction.

PrescribingTreatmentResource
Prescribed safer supplyFentanyl patch programBCCSU prescribed safer supply protocol
Prescribed safer supplySufentanil programBCCSU prescribed safer supply protocol
Prescribed safer supplyFentanyl tablet programBCCSU prescribed safer supply protocol

Rx instructions on the controlled prescription pad

Write "SA" on the duplicate prescription script

Prescribers are encouraged to add “SA” (safer alternative) in the “Directions for Use” section on the duplicate prescription pad.

duplicate prescription pad marked with safer alternative

 

Writing this code enables the pharmacist to enter this information into the PharmaNet database

Tracking on the Pharmanet database assists the MoH, MMHA, and partners, such as the BC Centre on Substance Use and the BC Centre for Disease Control, to conduct research. The information helps gauge the effects of safer supply, modify treatment programs, assess resource allocation needs, and to construct sound clinical practice guidelines.

Prescribed safer supply is an evolving practice. Registrants are encouraged to do all they can to ensure that it is better understood. Completing the form by writing “SA” is the first step in that endeavour.

Currently six people per day are dying of drug overdoses, which are most often linked to fentanyl in the illicit drug supply.