RN and RPN Perceptions and Experiences of Prescribing Opioid Agonist Therapy to People with an Opioid Use Disorder in British Columbia

Student summary

Why This Research Matters

British Columbia has been in a public health emergency over unregulated, toxic drug supply since 2016, and people are dying every day from drug poisoning. In September 2020, B.C.'s Provincial Health Officer issued an order that let registered nurses (RNs) and registered psychiatric nurses (RPNs) diagnose opioid use disorder (OUD) and prescribe opioid agonist therapy (OAT) — medication such as buprenorphine/naloxone that reduces cravings and withdrawal and helps people stabilize their lives. Before this order, prescribing these medications was limited to physicians (including psychiatrists) and nurse practitioners. This study, published in the Canadian Journal of Nursing Research by Amanda Lavigne, Jane Karpa, and Melissa White, set out to understand how RNs and RPNs across B.C. actually experience this new prescribing role.

The researchers used Sally Thorne's Interpretive Description approach, a qualitative method built for clinically applied nursing questions. It is designed to generate practical, clinically useful knowledge rather than testing a theory, which fits a study about a brand-new nursing role. The team recruited a purposeful sample of RNs and RPNs from across the province who were already prescribing OAT to people with OUD, and interviewed them about their day-to-day experiences and their perceptions of the role.

The abstract describes three broad areas of findings. First, nurse prescribers described both positive and challenging experiences delivering OAT — meaning the role brought real benefits for patients and for nurses' sense of practice, alongside real friction points in doing the work day to day. Second, the study surfaced operational and implementation considerations: the practical, systems-level details involved in setting up RNs and RPNs to prescribe safely, such as workflow, mentorship, and organizational support. Third, participants highlighted the particular strengths and flexibility RNs and RPNs bring to OAT care — for example, being embedded in community and primary care settings where people with OUD already access services, which can lower barriers to starting and staying on treatment.

The authors conclude that these findings matter beyond B.C. Other Canadian provinces considering whether to let RNs and RPNs prescribe OAT can look to this early experience as a real-world account of what expanding this scope of practice looks like from the inside, not just from a policy document.

It helps to understand the policy context. B.C. was the first Canadian province to allow this kind of nurse prescribing, initially training a small cohort of RNs and RPNs to prescribe buprenorphine/naloxone, with plans to expand to other OAT medications such as slow-release oral morphine and methadone. OAT itself is a well-established, evidence-based treatment: it reduces opioid use, improves how long people stay in treatment, and lowers overdose risk compared with counselling alone. This background is useful for understanding why the role was created, but it comes from public health sources, not from this particular study — keep the two separate as you review the article.

For nursing students, this study is a good example of interpretive description used to study a scope-of-practice change from the perspective of the nurses actually doing the work. As you read it, notice that the abstract gives you themes and categories but not exact numbers of participants, direct quotations, or a breakdown of how many nurses reported which experiences — those details would only be available in the full text. When appraising a qualitative study like this, ask what 'purposeful sample' means for who was and wasn't represented, whether the interview questions could have shaped what themes emerged, and how the researchers' framework (Interpretive Description) shaped what counted as a finding. Also think about transferability: what would have to be true in your own province or setting for these B.C.-based experiences to apply directly, versus what might need adaptation. This is a timely example of how nursing roles evolve in response to a public health crisis, and how qualitative research can capture the lived reality of that change for the nurses stepping into it.

Faculty notes

Educational Relevance

This Canadian Journal of Nursing Research article by Lavigne, Karpa, and White (2025) examines how registered nurses (RNs) and registered psychiatric nurses (RPNs) in British Columbia experience their expanded scope of practice as prescribers of opioid agonist therapy (OAT). The policy context is the September 2020 order from B.C.'s Provincial Health Officer authorizing RNs and RPNs to diagnose opioid use disorder (OUD) and prescribe pharmacological treatment — a scope expansion introduced in direct response to the province's ongoing unregulated drug poisoning crisis, which has caused daily deaths since 2016.

Methodologically, the study uses Sally Thorne's Interpretive Description, a qualitative approach purpose-built for applied disciplines like nursing, where the goal is to generate clinically actionable understanding of a phenomenon rather than to build or test formal theory. A purposeful sample of RNs and RPNs actively prescribing OAT was drawn from across B.C. and interviewed about their experiences and perceptions of the role. This is an appropriate design choice for a first look at a newly created scope of practice, where the priority is capturing practitioners' own framing of what the role involves before more structured or comparative research is possible.

The abstract reports findings in three clusters: (1) the positive and challenging dimensions of prescribing OAT as RNs/RPNs experience it day to day; (2) operational and implementation considerations relevant to standing up this role within existing systems and workflows; and (3) the particular strengths and flexibility that RN/RPN prescribers bring to OAT care, distinct from what physicians or nurse practitioners offer. The authors position these findings as directly relevant to other provinces weighing similar scope-of-practice expansions, framing the study as an evidence base for policy transfer rather than a purely local account.

For teaching purposes, this article is useful for several threads: scope-of-practice and role expansion in nursing, harm reduction and substance use nursing, health human resources policy in response to a public health emergency, and the use of Interpretive Description as a nursing-specific qualitative methodology. Instructors can pair it with the underlying B.C. policy order and with general OAT/harm-reduction literature (e.g., on buprenorphine/naloxone, methadone, and slow-release oral morphine) to give students the full context — while being careful to keep that background material clearly distinct from what this specific study found.

Appraisal points worth raising with students include: the abstract does not disclose exact sample size, interview count, saturation criteria, or specific quotations, all of which would be needed to fully judge rigour and depth; 'purposeful sample' recruitment may have selected more engaged or motivated prescribers, potentially skewing toward more positive accounts; single-province, single-jurisdiction findings limit generalizability to health systems with different regulatory, training, or resource contexts; and qualitative interpretive findings, while rich, cannot quantify how common each theme was across participants. Discussion could also address the tension between 'flexibility' as a strength and the need for standardized safety and mentorship structures noted in the operational-implementation theme. This is a strong prompt for discussing how nursing research can inform — and lag behind — rapid, crisis-driven policy change.