Preparing Correctional Nurses for Autonomous Opioid Agonist Therapy Prescribing

Problem Statement

            Utilization of Certified Opioid Use Disorder (C-OUD) RN/RPN prescribers within the Correctional Health Service for British Columbia (BC) has not been fully implemented or evaluated (Lavigne, Karpa, & White, 2025). Barriers to this include poor understanding of nurse role expansion and the complex nature of substance use disorders within the correctional health delivery context. Advocacy for incorporation of OAT nurse prescribers within BC Corrections has resulted in policy changes and educational opportunities to allow RN/RPNs to complete certification and provide this service within regulated parameters (BC College of Nurses and Midwives [BCCNM], 2026; B. Heer, personal communication, March 12, 2026). With the initial RN/RPN cohort at a selected BC Corrections facility completing the accredited program in August 2026, their transition into autonomous practice requires evaluation of program applicability, nurses' confidence, workforce readiness, and identification of implementation barriers.

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Proposed Intervention

            For RN/RPNs working in a selected BC Correctional Centre who successfully complete the BC Centre on Substance Use Certified Opioid Use Disorder (C-OUD) education and certification program (P), how does implementation of certified opioid use disorder (C-OUD) RN/RPN prescribing role (I), compared with pre-implementation practice under the existing NP/MD opioid agonist therapy (OAT) prescribing model (C), affect nurses’ knowledge of OUD management, confidence in autonomous OAT prescribing, perceptions of implementation barriers, and workforce readiness (O) during the first eight weeks following implementation (T)?

At a selected correctional facility in British Columbia, three nurses are completing the BC Centre on Substance Use (BCCSU) accredited program for certified nurse OAT prescribing. The first cohort is small in number due to the investment of compensated time and additional supports required for 60-hours of individual instruction (BCCSU, 2025b). If the instillation of nurse-led OAT prescribing is successful, larger cohorts could potentially be supported to complete the training. Although this role has been evaluated in practice for community implementation outcomes (Lavigne et al., 2025; Robinson et al., 2024), it has not previously been examined for nurse outcomes in the correctional system.

This project will evaluate implementation readiness following completion of the BCCSU education pathway by the first cohort of correctional nurses to operate with an expanded scope at the correctional centre. It will evaluate nurses’ understanding of OUD management, their confidence in providing autonomous OAT care, and perceived barriers to providing nurse-led OAT in the correctional setting. This will be measured prior to their provision of direct patient care and eight weeks following implementation of this role change. Additionally, the survey will evaluate the applicability of the education pathway to corrections and the ease of completing the program.

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Evidence Base

            C-OUD nurse prescribing is a BC-specific model created to address persistent gaps in OAT access, especially in settings with limited NP/MD availability (BC Ministry of Health, 2021; Lavigne et al., 2025). An accredited curriculum was developed by BCCSU and BCCNM under the 2021 provincial mandate to provide comprehensive training for RN/RPN prescribing authority (BC Ministry of Health, 2021). Community studies show that certified RN/RPN prescribers expand timely, flexible OAT access for marginalized groups through opportunistic, relational care supported through standardized BCCSU decision-support tools and BCCNM regulations (Banka-Cullen et al., 2023; Robinson et al., 2024). In correctional settings, delayed OAT initiation and untreated withdrawal contribute to diversion, acute morbidity, and high post-release fatal/non-fatal opioid toxicity, while early guideline-driven OAT and withdrawal management markedly improve safety and mortality outcomes (Berk et al., 2024; Evans et al., 2023; Fischer et al., 2025). Despite these benefits, nurse-prescribed OAT has not been fully implemented or evaluated in BC Corrections (Lavigne et al., 2024; Robinson et al., 2024), underscoring the need to assess nurses’ OUD knowledge, prescribing confidence, perceived barriers, and readiness for autonomous practice in the correctional setting after completion of an accredited education program.

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Implementation Plan

            Pre- and post-implementation surveys containing quantitative and qualitative questions will be administered via REDCap software to collect data. Prior to starting on-site prescribing, the C-OUD nurse will complete an anonymous REDCap survey. During the eight-week implementation period, nurses will receive practice support from nurse practitioners, physicians, and organizational resources. At the completion of the eight-week pilot, nurses will complete a follow-up survey to evaluate changes in knowledge, confidence, perceived barriers, and applicability of the education pathway to correctional practice.

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Data Analysis

            Analysis of the pre- and post-implementation data will be conducted at the group level using descriptive statistics. It will summarize changes in nurses’ OUD knowledge, confidence in prescribing autonomous OAT, perceived implementation barriers, and workforce readiness over the eight-week period. Likert-scale items will be reported using group means, medians, ranges, and standard deviations. This allows for comparison of pre- and post-scores without linking individual responses (Mohd Rokeman, 2024). Qualitative comments will undergo thematic content analysis to identify similar and dissimilar perceptions of role clarity, the applicability of the BCCSU C-OUD education pathway, and correctional-specific implementation challenges (Meadows-Oliver & Kapaale, 2023). Quantitative and qualitative findings will be integrated through mixed-methods synthesis to assess early group-level readiness for autonomous C-OUD RN/RPN prescribing within the correctional setting.

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Expected Outcomes

            Upon completion of the BCCSU C-OUD education pathway, it is anticipated that nurses will gain knowledge of OUD management, including pharmacological and non-pharmacological strategies (BCCSU, 2024, 2025a). During the eight-week implementation period, nurses are anticipated to gain confidence in autonomous OAT prescribing, apply new clinical competencies with male inmates requiring OAT, and identify correctional-specific barriers affecting role integration. These changes reflect early indicators of workforce readiness for autonomous OAT practice at a specific correctional site after completion of the accredited education pathway.

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Implications

            Evaluating the first cohort of C-OUD RN/RPN prescribers in BCC will generate foundational evidence to guide safe and effective integration of autonomous nurse-led OAT care in a setting where delayed treatment, withdrawal, and limited NP/MD availability contribute to post-release fatal/non-fatal toxicity risk (Evans et al., 2023; Fischer et al., 2025). Understanding nurses’ OUD knowledge, prescribing confidence, and perceived barriers will inform workforce readiness, refine role supports, and identify operational challenges unique to correctional workflows. These insights may strengthen alignment with BCCUS and BCCNM regulatory expectations and support the broader adoption of nurse-prescribed OAT models that have been shown to improve access for marginalized populations (Banka-Cullen et al., 2023; Robinson et al., 2024).

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Conclusion

            C-OUD RN/RPN OAT prescribing offers a promising strategy to address disparities in OAT access within a selected BC correctional facility, yet its implementation and nurse-level outcomes remain unevaluated. This project provides the first corrections-specific assessment of autonomous C-OUD nurse prescribing, examining changes in OUD knowledge, prescribing confidence, and perceived barriers over an eight-week period. Grounded in evidence demonstrating the importance of timely, guideline-driven OAT and withdrawal management in reducing fatal/non-fatal opioid toxicity, this evaluation will inform future program development, strengthen role clarity, and support improved care delivery for male inmates with OUD.

 

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References

Banka-Cullen, S. P., Comiskey, C., Kelly, P., Zeni, M. B., Gutierrez, A., & Menon, U. (2023). Nurse prescribing practices across the globe for medication-assisted treatment of the opioid use disorder (MOUD): A scoping review. Harm Reduction Journal, 20(1), Article 78. https://doi.org/10.1186/s12954-023-00812-y

BCMHSUS Research Committee. (2022). BCMHSUS research operational approval to conduct research: Guidelines updated July 2022.  https://www.phsa.ca/researcher/Documents/BCMHSUS%20Research%20Operational%20Approval%20Guidelines%20%28July%202022%29.pdf

Berk, J., South, A.-M., Martin, M., James, M.-E., Miller, C., Haber, L., & Rich, J. (2025). Medication for opioid use disorder service delivery in carceral facilities: Update and summary report. Health & Justice, 13(1), Article 8. https://doi.org/10.1186/s40352-025-00317-9

British Columbia Centre on Substance Use Disorder. (2024). Decision support tool for Registered Nurse/Registered Psychiatric Nurse opioid use disorder certified prescribing of buprenorphine. https://www.bccsu.ca/wp-content/uploads/2024/10/DST-RN-RPN-Buprenorphine-naloxone-Extended-release-Buprenorphine.pdf

British Columbia Centre on Substance Use Disorder. (2025a). Decision support tool for Registered Nurse/Registered Psychiatric Nurse opioid use disorder certified prescribing of methadone and slow-release oral morphine. https://www.bccsu.ca/l/wp-content/uploads/2023/11/DST-Certified-Practice-SROM-Methadone.pdf

 

 

British Columbia Centre on Substance Use. (2025b). Registered Nurse/Registered Psychiatric Nurse opioid use disorder certified education and training pathway. https://www.bccsu.ca/provincial-opioid-addiction-treatment-support-program-poatsp/authorized-registered-nurse-and-registered-psychiatric-nurse-education-and-training-pathway/

British Columbia College of Nurses and Midwives. (2026). Certified registered nurses: Opioid use disorder [Practice standard]. https://www.bccnm.ca/RN/PracticeStandards/Pages/CPoud.aspx

British Columbia Ministry of Health. (2021). Service delivery framework: Registered nurse and registered psychiatric nurse prescribing as a provincial overdose response initiative. https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/service-delivery-framework-rn-rpn-prescribing.pdf

Evans, E. A., Wilson, D., & Friedmann, P. D. (2022). Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug and Alcohol Dependence, 231, Article 109254. https://doi.org/10.1016/j.drugalcdep.2021.109254

Fischer, B., Moghimi, E., Robinson, T., & Johnson, S. (2025). Substance use-related overdose among incarceration-exposed individuals: A recent literature compilation and review (with primary focus on North America). Correctional Service Canada. https://publications.gc.ca/collections/collection_2025/scc-csc/PS83-3-486-eng.pdf

Lavigne, A., Karpa, J., & White, M. (2025). RN and RPN perceptions of prescribing opioid agonist therapy to people with an opioid use disorder in British Columbia. Canadian Journal of Nursing Research, 57(4), 546-557. https://doi.org/10.1177/08445621251366562

Meadows-Oliver, M. & Kapaale, C. (2023). Critically appraising qualitative and mixed methods evidence for clinical decision making. In B. M. Melnyk & E. Fineout-Overholt (Eds.),  Evidence-based practice in nursing & healthcare (5th ed, pp. 266-297). Wolters Kluwer.

Mohd Rokeman, N. R. (2024). Likert measurement scale in education and social sciences: Explored and explained. EDUCATUM Journal of Social Sciences, 10(1), 77-88. https://doi.org/10.37134/ejoss.vol10.1.7.2024

Robinson, S., Callegari, K., Blawatt, S., Dong, H., & Lambert, S. (2024). Provincial evaluation registered nurse and registered psychiatric nurse prescribing of OAT initiative. Ministry of Mental Health & Addictions. https://www2.gov.bc.ca/assets/gov/health/managing-your-health/mental-health-substance-use/provincial_evaluation_report_27june2024.pdf