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Working in small northern and interior First Nations communities scattered across hills and winding valleys, registered nurse听 Kate Hodgson says finding treatment options for people who use听 substances can be just as difficult as navigating the landscape itself.
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Many communities are听 visited by a family doctor only one or two days a week. Travel to larger听 centres with more resources can be expensive, dangerous or even听 impossible with bad weather.听
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Family physicians can also be hesitant to听 adopt safer supply approaches like prescribing pharmaceutical听 alternatives to illicit drugs, even to people at extremely high risk of听 overdosing.
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鈥淲e have mountains and forests and rivers,听 and we have so much to work through to get people the care that they听 need,鈥� said Hodgson, the practice consultant for substance use with the听 First Nations Health Authority.
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But soon she will have one more option for patients who use substances.
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Hodgson is among 30听 registered and psychiatric nurses in British Columbia who will be able听 to prescribe Suboxone, a prescription opioid substitute, by the end of听 the month, the province announced today.
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The approach is part of a new effort to听 prevent overdoses and deaths made possible by a September order from听 provincial health officer Dr. Bonnie Henry granting nurses prescribing听 powers to treat substance use.
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鈥淭his can really save someone鈥檚 life,鈥� said听 Hodgson. 鈥淏ecause in that moment, when we are having those pressing听 conversations with people, to be able to just offer it without having to听 get in the boat and row across the river and hike up the mountain, it鈥檚听 life-changing.鈥�
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Registered nurses and registered听 psychiatric nurses are joining physicians, pharmacists and nurse听 practitioners as points of access for pharmaceutical alternatives to听 street drugs, a move experts say will benefit rural and remote听 communities in particular.
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Amanda Lavigne, a registered psychiatric听 nurse in Kamloops who supports nurses throughout Interior Health in听 treating substance use, said it鈥檚 an important change.
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鈥淭his is just new ways of practising. Our听 scope has been broadened quite drastically, compared to what I think听 nursing has really ever been used to seeing,鈥� she said.
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A range of approaches are included in听 discussions around safer supply programs. The nurses will be able to听 prescribe substances like Suboxone with the aim of reducing people鈥檚 use听 of illicit street drugs.
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Critics say that falls short of true safer听 supply, which would provide pharmaceutical-grade versions of illicit听 substances instead of alternatives.
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The first cohort is only trained to听 prescribe buprenorphine/naloxone, known as Suboxone, but training for听 other alternatives like slow-release oral morphine and methadone will听 come in later phases.
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Research from the BC Centre on Substance听 Use suggests around 83,000 people have opioid dependence in B.C., while听 only about 23,000 people in B.C. have access to any form of opioid听 substitute treatment.
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Just under 4,000 of those have access to听 pharmaceutical-grade versions of street drugs through safer supply听 programs, the vast majority of which are prescribed the oral tablet听 hydromorphone.
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Last year, 1,548 people died of overdoses听 between January and November, placing 2020 on track to be the deadliest听 year for overdoses in B.C.
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Lavigne said seeing the听 crisis worsen during her more than decade-long career has made her and听 her colleagues keen to do more, even before the pandemic undid much听 recent progress to curb deaths.听
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鈥淪eeing the numbers and the bigger picture, that really anchored me as a clinician.鈥�
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Emma Garrod, a registered nurse and听 clinical project manager with the BC Centre on Substance Use, says the听 decision to start with Suboxone was made because it is usually the first听 opioid replacement treatment tried with a new patient.
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鈥淚t鈥檚 a pretty big leap to prescribe a听 controlled substance as opposed to starting someone with Tylenol,鈥� said听 Garrod. 鈥淚t鈥檚 a large leap for the college and it鈥檚 precedent-setting in听 North America.鈥�
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Garrod led the development of the training听 in concert with the BC College of Nurses and Midwives and said it was a听 challenge because prescribing isn鈥檛 really part of a nursing education.
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But the training is 鈥渞eally building on a very strong foundation that nurses already have,鈥� said Garrod.
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This first cohort of nurses did听 pre-existing online opioid prescribing training for physicians and听 pharmacists and then completed a specially designed workbook on the听 prescribing process during distanced, in-person training in smaller听 groups last month.
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In the next few weeks they are finishing听 their in-person training with current prescribers and substance use听 experts throughout the province.
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The training will continue to quickly scale up the number of nurse prescribers available.
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All three said nurses have a unique role听 that puts them in a strong position to help people who use substances听 access alternatives, particularly in smaller communities where they may听 be the only full-time health-care professionals.
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鈥淣urses have a differently facing role with听 clients than physicians do,鈥� Lavinge said. 鈥淭hey鈥檙e in a position to听 reach out to clients, for creating those relationships in the听 community.鈥澨�
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鈥淢any nurses here鈥� they just wish they could do more.鈥�
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Providing expanded substance use care is听 particularly important in First Nations communities and for Indigenous听 people in urban centres who experience frequent and systemic racism in听 health care.
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Indigenous people in B.C. are much less likely to have access to primary care, which a recent report found results in poorer health outcomes across the board, especially for women.
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First Nations people account for 16 per听 cent of overdose fatalities despite making up only 3.3 per cent of the听 B.C. population. First Nations women are nearly twice as likely to die听 of an overdose as non-First Nations women, according to the report.
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鈥淔or us, having nurses prescribing safer supply, we鈥檙e really helping address those gaps,鈥� said Hodgson.
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Garrod said the training will evolve based听 on feedback and questions from nurses as they begin to prescribe and听 that will shape training for expanded prescription abilities to provide听 safer alternatives to other substances.
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Garrod said the work also begins to break听 down stigma around substance use and remove barriers to care for the听 people who need it most.
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鈥淭here are many other elements of care and听 changes needed, and this is one part of it,鈥� said Garrod. 鈥淚t鈥檚 a really听 big step for a lot of more rural and remote places that need access to听 prescribers.鈥�
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