Nurse Practitioner Authority to Prescribe Suboxone

On October 20, 2017 Buprenorphine-Naloxone (Suboxone) and Methadone were designated by the NL College of Nurses as drugs Nurse Practitioners (NPs), who meet specified education and practice requirements, may prescribe for the treatment of opioid use disorder (OUD) deemed appropriate for a specific client. NPs must complete ALL of the identified education and practice requirements to prescribe buprenorphine-naloxone (Suboxone) and Methadone for OUD as specified below and receive authorization from the College.

Requirements for Nurse Practitioners to Prescribe Buprenorphine-Naloxone (Suboxone) and Methadone for Opioid Use Disorder (OUD)

Nurse Practitioners who prescribe buprenorphine-naloxone (Suboxone) and Methadone for OUD must have the individual competence (necessary knowledge, skills, and judgement), including the following:

• Be currently licensed as an NP with authority (without restrictions) to prescribe controlled drugs and substances (CDS).
  • Participate in the Provincial Prescription Monitoring Program.
  • Complete training for the Tamper Resistant Prescription Drug Pad Program and adhere to the ongoing practice requirements of the program
  • Be registered with Newfoundland and Labrador Health Services Health Information System – CorCare or CorCare Link – to review a patient’s current medication profile before prescribing buprenorphine-naloxone (Suboxone) and Methadone.
• Complete specified education and practice requirements to obtain competence in prescribing buprenorphine-naloxone (Suboxone) and Methadone:
  • Complete the British Columbia Centre on Substance Use Provincial Opioid Addiction Treatment Support Program (or a course/educational program deemed equivalent by the College) or the Centre for Addiction and Mental Health (CAMH) Opioid Use Disorder Treatment Course.
    • For individuals completing the BC Course, there are 4 different streams (modules) available:
      • 1: Buprenorphine/naloxone
      • 2: Oral OAT (community settings)
      • 3: Oral OAT (acute care settings)
      • 4: Injectable OAT (iOAT)
        Modules #1 and 4 are required for all. Depending on where you will be practising (community or acute care) you may be required to complete one or both streams (Modules #2 and/or 3).
  • Complete the College of Physicians & Surgeons of Newfoundland and Labrador’s (CPSNL’s) Introduction to Safe Prescribing: Opioids, Benzodiazepines, and Stimulants Course available through MDcmeca.
  • Attend a minimum of two days of clinical training (or a combination of equivalent hours) with an experienced practitioner/team in the treatment of OUD and the provision of buprenorphine-naloxone (Suboxone) and Methadone.
  • Be knowledgeable of CPSNL documents related to OUD.
  • Be knowledgeable of College of Pharmacy of Newfoundland and Labrador (CPNL) documents related to OUD.
  • Have access to urine drug screening and/or other forms of screening if deemed appropriate for testing of drugs for possible abuse/misuse.
• As a part of ongoing continuing education in opioid dependence and addiction disorders, NPs may complete the CAMH Opioid Dependence Treatment (ODT) Certificate Program or a course/educational program deemed equivalent by the College.
• As new requirements for Opioid Use Disorder treatments and medications evolve, NPs must ensure they meet the additional requirements to prescribe these medications (e.g., any required education to prescribe Sublocade, diacetylmorphine, etc.).
• If the NP is away from the practice setting for an extended period of time, the NP must reflect on what educational requirements are needed to ensure the NP has the individual competence (necessary knowledge, skills, and judgment) to prescribe buprenorphine-naloxone (Suboxone)/Methadone.
• NPs may wish to consult with the NL Centre for Substance Use (NLCSU) if deemed appropriate.

Application Process Requirements:

Before being granted the authority to prescribe buprenorphine-naloxone (Suboxone) and Methadone for OUD by the College, NPs must:

• Complete the Authority to Prescribe Buprenorphine-Naloxone (Suboxone) and Methadone for Opioid Use Disorder application form and submit to the College. NPs can access the application form on the College website.
• The application form will include a section where:
  • The NP requests to be granted authority to prescribe buprenorphine-naloxone (Suboxone) and Methadone for OUD in their practice setting with rationale for the request.
  • The employer provides written confirmation of employer support and polices for the NP to prescribe buprenorphine-naloxone (Suboxone) and Methadone for OUD in their practice setting. The NP must have policies to guide their practice related to prescribing Suboxone and Methadone and care of clients receiving Opioid Agonist Therapy.
  • The applicable practitioner/team indicates the NP successfully completed two days of training in prescribing buprenorphine–naloxone (Suboxone) and Methadone for OUD.
• NPs will be required to submit certificate(s) of completion of required courses to the College.
• Once the application(s) is reviewed and deemed to have met all requirements, the NP will be granted authority by the College to prescribe buprenorphine-naloxone (Suboxone) and Methadone for OUD.
• The NP will be notified by the College confirming authority to prescribe buprenorphine-naloxone (Suboxone) and Methadone for OUD has been granted.
• A website notification of authorized prescribers will be posted on the College’s public directory under “Search for a Nurse”.
• NPs are permitted to change practice settings without further authorization from the College if they have the appropriate employer authorization.

In addition, NPs who are practising outside of the Provincial Health Authority must follow ALL of the requirements detailed above and:

• Declare that they have access to a mentor who has expertise in substance use disorders, addictions management, and/or opioid use disorder (OUD) and has expertise in prescribing of buprenorphine– naloxone (Suboxone) and Methadone for OUD.
• Declare they have policies to guide their practice related to the prescribing of buprenorphine-naloxone (Suboxone) and Methadone and care of clients receiving buprenorphine-naloxone (Suboxone) and Methadone for OUD.

Note: Authorization to prescribe Suboxone also authorizes an NP to prescribe Sublocade if they successfully complete the appropriate manufacturer’s training certificate program.