Improving Access to iOAT: Increasing the Number of Prescribers
One significant barrier to accessing medications to support non-toxic substance and/or to treat opioid use disorder - called opioid agonist therapies or OAT - is the insufficient number of prescribers. This causes long waitlists to see a prescriber, which may deter patients from starting treatment. Some patients who live in rural, remote and northern regions travel hours to receive dosages of OAT. Group members identified the need for prescribers as a crucial aspect of reducing the overdose crisis.
“We don’t only want a handful of doctors or nurse practitioners to write that script.
We want all doctors, all nurse practitioners to write that script.”
I personally believe that we should be able to buy drugs with all the consumer protection that people get when they buy nicotine or alcohol and that’s how I would like to see it. You know, the fact of, you know, the actual prohibition, is the part that makes everything to be allowed to do anything and everything.
“[We need to] remove some of these barriers and get more doctors and nurse practitioners to prescribe, to prescribe the people what they need. If they can, if they, you know, and doing so, you know, people will be, we wouldn’t have so many overdoses.”
There are many reasons why there aren’t more doctors and nurse practitioners (NPs) prescribing OAT, including:
Doctors who are paid by fee-for-service, meaning they won’t be paid if a patient does not show up. These doctors may be hesitant to take on patients requiring OAT due to the perception that people who use drugs (PWUD) aren’t reliable in showing up for appointments
Practitioner concerns that they do not have sufficient education/training to provide OAT
Primary care physicians and NPs are often not provided substance use disorder education/training as an entry-level competency
Unaware of Health Canada and physician regulatory college policies re: prescribing OAT
There’s also the issue of the overall number of doctors and NPs in Canada which is less than 100,000, and the vast majority are concentrated in urban areas. Meanwhile, Canada has over 300,000 registered nurses (RNs) who, with the right education and training, could have the competencies to prescribe OAT. However, this would require authorization by the federal government, as well as RNs’ respective provincial regulatory bodies and employers. British Columbia (BC) is trying to change that.
As of July 2020, in response to the record high number of reported opioid-related overdoses and overdose-related deaths throughout the COVID-19 pandemic, RNs and RPNs in BC have been given temporary authority to prescribe buprenorphine/naloxone to treat opioid use until September 2021. These exemptions are temporary and will be rescinded on the date that the emergency related to toxic, illegally produced opioids and the increase in people overdosing and dying “has passed.” At the time of writing, RNs and RPNs in BC are only authorized to prescribe buprenorphine/naloxone, as the additional required supports and resources in order to prescribe all other OAT medications are under development.
While there has been improvement over the years with a push to educate more practitioners about OAT in school and after, there is still a long way to go.