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B.C. nurses will be able prescribe drugs to help stop overdose deaths

Advocates are hailing this new public health order as a major step in the battle to save lives
Needles are seen on the ground in Oppenheimer park in Vancouver's downtown eastside on March 17, 2020. THE CANADIAN PRESS/Jonathan Hayward

By Camille Bains, The Canadian Press

VANCOUVER — Registered and psychiatric nurses in British Columbia will be able to prescribe safer drugs for people at risk of overdose under a new public health order that advocates are hailing as a major step in the battle to save lives.

Provincial health officer Dr. Bonnie Henry's order comes as B.C. experiences a record number of monthly overdose fatalities with border closings during the COVID-19 pandemic being blamed for more toxic drugs on the streets.

Henry said Wednesday that new nursing standards will be introduced, along with training, education and access to expert consultation through the BC Centre on Substance Use, which has been training doctors to prescribe medications like hydromorphone.

More than 5,000 people have fatally overdosed in B.C. since the province declared a public health emergency in 2016, but fatalities were declining before COVID-19.

Only doctors and nurse practitioners are currently able to prescribe drugs, including substitute medications for illicit-drug users as an alternative to potentially deadly substances on the street.

Henry said expanding the number of health professionals who can prescribe could lead to connections that prompt those with entrenched addictions to seek help.

"When people are using drugs, it's not the shunning and the shaming that's going to help them," she said. 

"Right now, the toxicity of the drugs that are on the street is so high that we're losing our colleagues, our friends, our family members before they've even had a chance to connect with people."

Henry said registered and psychiatric nurses working on outreach teams in the community would be able to prescribe the medications to people seeking services.

Drug users could also be given prescriptions in hospital when they're seeking psychiatric care, and more people struggling with addiction will be reached in rural and remote areas where nurses are often providing primary care, she said.

Hydromorphone pills are being prescribed, but injectable and powder forms of the drug as well as other medications are under consideration as alternatives to substances such as fentanyl, Henry said.

A spokeswoman with the B.C. College of Nurses and Midwives said its board is expected to review standards related to the order at a meeting on Sept. 24 and to set a date to start the new service, which could be 30 days later.

The latest data from the BC Coroners Service from July shows there were 175 suspected illicit drug toxicity deaths, but the province set a monthly overdose record in June with 177 fatalities.

In March, British Columbia temporarily expanded access to a safer supply of prescription drugs due to concerns about a high number of overdose deaths among isolated drug users during COVID-19.

The ministries of Health and Mental Health and Addictions will expand that access by working with Henry's office to increase the types of medications that can be prescribed and dispensed by doctors, pharmacists and nurses.

Henry has been an advocate for access to a safer supply of drugs and has called on the federal government to decriminalize possession of small amounts of drugs for personal use.

Canada's chief public health officer, Dr. Theresa Tam, has also called for access to safer prescription drugs.

Prime Minister Justin Trudeau recently agreed a safer supply is key during the dual public emergencies of a pandemic and the overdose crisis, but he has maintained his stance against decriminalization.

Guy Felicella, peer clinical adviser with the Overdose Emergency Response Centre and the BC Centre on Substance Use, said Henry's order will provide a lifeline to drug users.

"This is what people have been calling for," he said, adding the order goes beyond guidance for prescribing safer drugs.

Expanding the number of prescribers is a positive step toward building a system of care that includes harm reduction treatment and recovery, Felicella said.

"It's probably what I would compare to as this era's Insite," he said of Canada's first supervised injection site, which opened in Vancouver in 2003.

Mental Health and Addictions Minister Judy Darcy said an interim measure adopted in March to provide isolated drug users with prescription alternatives during COVID-19 will be broadened to include anyone at risk of overdose after they've had a medical evaluation.

Darcy said the long-called-for safer supply of drugs policy, along with investments in outreach teams, increased youth treatment beds and greater access to addiction counselling, is aimed at tackling the overdose crisis with medicine.

"This is a health issue, it's an illness," she said.

"This is about prescription alternatives to separate people from the poisoned drug supply because we need to ensure people are alive so that we can connect them to building a healthier life."

This report by The Canadian Press was first published Sept. 16, 2020.