Hundreds of British Columbia naturopaths want to be able to prescribe “safer supply” and other medications to treat substance-use disorders and be part of the response to the province’s toxic drug crisis, as their profession is not given such powers by existing regulation.
The BC Naturopathic Doctors Association said in a news release Thursday that more than 250 naturopathic doctors have enrolled in a provincial education and training program to prescribe common medications for opioid use disorder, such as methadone. Fifty members in 30 communities have already started training, the association says.
Vanessa Lindsay, BCND president and a Vancouver-based naturopath, has also written to B.C. Minister of Mental Health and Addictions Jennifer Whiteside seeking such prescribing powers. On Wednesday, Ms. Whiteside replied to say the proposal had been forwarded to Health Minister Adrian Dix, who is responsible for the scope of practice of regulated health professionals under the Health Professions Act.
“We’re in the midst of a health care crisis, on so many fronts, and there are so many ways that naturopathic doctors can help with the current crisis,” Dr. Lindsay said in an interview. “This is one area that we know is especially in need of providers and support.”
B.C. is in its eighth year of a public-health emergency declared in response to soaring illicit drug deaths caused by increasingly toxic drugs. At least 2,511 people died in 2023 – a grim record equating to about seven British Columbians each day.
The provincial opioid addiction treatment support program is offered through the B.C. Centre on Substance Use to provide training and education on prescribing opioid agonist treatments, and does not include pharmaceutical alternatives to toxic, illicit drugs, an intervention commonly called safer supply.
Enrolment in the online portion of program is open to anyone, but only approved disciplines – which do not include naturopathic doctors – are able to complete the in-person preceptorship portion required for certification to prescribe, according to the centre. Dr. Lindsay said that the inability of naturopaths to access that preceptorship is one barrier moving forward.
Prescribing authority ultimately rests with Health Canada, the B.C. government and regulatory colleges, and requires changes to respective regulations and provincial processes.
B.C. naturopaths were authorized in 2009 to prescribe certain drugs. The BCND says there are now more than 700 licensed naturopathic doctors in the province, with more than 85 per cent prescribing.
In September, 2021, B.C. opened the door to allow registered nurses and registered psychiatric nurses to diagnose and treat substance-use disorders, including prescribing controlled drugs – the first jurisdiction in Canada to do so. The change was made permanent last November with a new designation of a certified practice, a process that involved the B.C. government amending the Nurses (Registered) and Nurse Practitioners Regulation, updating scope of practice documents, ordering controlled prescription pads, securing PharmaNet access and more.
As of last August, 459 patients had filled prescriptions for methadone, Suboxone or slow-release oral morphine written by 48 registered nurses or registered psychiatric nurses.
A growing body of evidence has shown that providing pharmaceutical alternatives to the toxic drug supply can reduce overdose deaths and related harms. The first population-level evaluation of the controversial strategy, published last month in the British Medical Journal, found that British Columbians who were at risk of death from illicit opioid use were 61 per cent less likely to die from any cause the following week if prescribed at least one day’s supply of a pharmaceutical alternative. Those prescribed four days or more were 91 per cent less likely to die the following week from any cause.
However, while an estimated 225,000 people in B.C. use illicit drugs, with more than 100,000 of those diagnosed with an opioid-use disorder, only about 4,200 people can access prescribed alternatives, with part of the challenge being the resource-intensive nature of clinicians having to prescribe to each patient.
Provincial Health Officer Bonnie Henry has recommended expanding access by providing the medications through multidisciplinary clinics or health authority overdose prevention sites, while an expert panel convened by the BC Coroners Service has recommended doing away with the need for prescriptions – the latter of which the province has repeatedly rejected.
Andrea Woo