January 29, 2026
Written by: Kaitlyn Singh, RN, NP student, School of Nursing, University of Victoria
The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policies, positions or guidance of NNPBC. This content is provided for general information purposes and does not constitute professional, clinical or legal advice.
The toxic drug crisis claims an average of six lives per day in British Columbia. These lives lost highlight an urgent need for increased access to timely, evidence-based, voluntary treatment for substance use disorder.
Substance use disorder, once seen as a moral failing, is now recognized as a chronic and treatable condition, with medications for opioid and alcohol use disorders shown to be highly effective in reducing mortality, infectious disease and improving sobriety.
The following article summarizes existing substance use care challenges and offers a nurse practitioner solution – a solution which is currently underutilized in BC.
Substance use care challenges
At present, the responsibility for substance use care falls on addiction medicine clinics, family care providers and emergency rooms. Addiction medicine clinics only operate during regular business hours and family providers have lengthy waitlists and appointment delays.
As a result, the emergency room (ER) is too often the default access point despite it posing significant challenges to providing substance use care. ER physicians face institutional resistance, provider stigmatization, time constraints, liability concerns and limited training; all contributing factors to a lack of prescribing appropriate medication for those with substance use disorder.
There is a window of opportunity when people struggling with substance use are most receptive to change and intervention. This can happen at any time, and when it does, it requires immediate, low-barrier access to supportive, patient-centered and competent care. Without responsive intervention in community, patients present to ERs for help or after experiencing an overdose, increasing healthcare costs and resulting in fragmented and inconsistent care.
Community substance use care teams, such as the Integrated Homelessness Action Response Team (IHART), Overdose Outreach Team (OOT) and Substance Use Access Services Team (SUSAT), employ outreach strategies and harm reduction perspectives to provide low-barrier care and trust-building to keep people alive, connected, safe and supported. However, the current teams in BC are not staffed with clinicians with specialized training in addiction medicine, limiting their ability to provide timely treatment on demand (i.e., when someone is ready and asking for access to treatment) and leaving a critical gap in access to voluntary substance use care.
A proposed substance use care solution
To increase access to voluntary treatment in BC and meet the treatment access demands, Nurse Practitioners (NPs) with a substance use specialty (SUNP) could be embedded into existing community substance use care teams. The proposed solution would incorporate one SUNP into each community team, bringing robust diagnostic and prescriptive skillsets.
The mandate of the SUNP would focus on adults with substance use disorder, offering in-person outreach, virtual telehealth appointments and on-call hours to align with late-hour pharmacies. This would include individualized assessments, prescribing and monitoring medications, psychosocial support, education and referrals.
In this proposed solution, SUNPs would collaborate with registered nurses, social workers and private family providers to enhance the team approach therefore ensuring continuity of care and safe patient treatment plans.
Nurse practitioner opportunities
Despite overwhelming research that substance use disorder medications improve quality of life, employment and social engagement, these treatments remain underutilized due to stigma, limited provider knowledge, poor accessibility and delays. This underutilization results in worsening health outcomes, overdose and strains on emergency services. SUNPs embedded within community teams could directly address these barriers by expanding access to evidence-based addiction care.
Unlike traditional healthcare settings, SUNPs can provide immediate, low-barrier support to those who may not otherwise access care. Notably, a shortage of education, knowledge and training among providers has been identified as a barrier to the effective prescribing of addiction medications. SUNPs have the opportunity to overcome this challenge through the specialized training provided by The British Columbia Centre on Substance Use (BCSSU) Addiction Fellowship. This fellowship offers 12 months of addiction mentorship and clinical experience to develop evidence-based practice.
SUNPs can also increase access to substance use disorder medications, such as those for opioid use disorder, which are proven to decrease overdose and all-cause mortality (death by any disease) by 50%. Substance use disorder medications are well-researched and help reduce cravings, prevent withdrawal and support patients in achieving sobriety. Similarly, relapse prevention medication used for alcohol use disorder remains under-prescribed despite its proven effectiveness in helping people stop or reduce drinking. These medications also help to prevent alcohol related liver disease and reduce social harms such as crime, motor vehicle accidents and accidental deaths.
By integrating SUNPs into community teams, patients would receive faster access to these critical treatments, resulting in improved clinical outcomes, reduced ED visits and fewer preventable deaths. This proposal aligns directly with the provincial Minister of Health's mandate to enhance access to addiction treatment. SUNPs will eliminate barriers to care, delivering timely treatment patients deserve to achieve lasting recovery and improved health outcomes.
More accessible, less costly
Integrating SUNPs into the community presents a strategic solution to the escalating cost of substance use. SUNPs will provide specialized treatment for substance use disorders within primary care, reducing the reliance on expensive acute care services. In 2020, the economic toll of substance use in Canada was reported at $49.1 billion, with 27% related to hospitalizations, emergency visits and other related healthcare costs. ER care is expensive, with an estimated 15% of visits being for conditions that could be managed in primary care settings, including substance use disorders.
SUNPs provide an evidence-based solution by transitioning substance use care from high-cost acute settings, such as ERs, to proactive, community-based treatment. Research confirms that NP-led clinics are cost-effective and efficient in increasing accessibility and reducing long-term healthcare costs. Embedding SUNPs into community teams will expedite substance use care, reduce ER overreliance and lower unnecessary hospitalizations while also increasing access to voluntary approaches to treatment.
Redirecting substance use care to SUNPs is a key step to ensuring ERs remain open for urgent, life-threatening situations while streamlining addiction treatment with specialized providers. This proposal aligns with the Minister of Health's priority of reducing administration costs of the healthcare system and focusing on front-line resources. SUNP-led care will improve healthcare sustainability and ensure those with substance use disorder receive the specialized care they need in a timely and cost-effective manner.
About the author
Kaitlyn Singh
Kaitlyn Singh, RN, is a Nurse Practitioner student graduating in July 2025. She has varied nursing experience and particular interests in harm reduction, health equity, and primary care, focusing on caring for people who use substances.
Acknowledgment: I would like to thank Dr. Marilou Gagnon for providing feedback on my original work and for offering edits to this piece.
Marilou Gagnon
Dr. Marilou Gagnon is a Professor in the UVic School of Nursing and an Affiliative Scientist with the Canadian Institute for Substance Use Research. Her program of research seeks to address gaps in knowledge that have the potential to inform public debate and policies, while also advancing the rights and the health of marginalized communities.
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