Runtime: 29:09
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SHOW NOTES
Summary
In this episode, host David P. Ball speaks with Marjory Ditmars, a nurse practitioner with over a decade of experience in low-barrier addiction care, and Dominik, who shares lived experience of initiating and stabilizing on opioid agonist treatment (OAT). The guests share insight into the clinical and relational work of initiating OAT, strategies for stabilization, barriers that patients face, and how trauma-informed, patient-centred approaches can support long-term engagement. The episode highlights real-world examples of OAT initiation, outreach, partnerships with other providers, and the importance of patience with care approaches.
Learning Objectives
- Describe the key steps in initiating OAT and why the first phase is critical for long-term retention.
- Explain different OAT and considerations for selecting different medications.
- Identify barriers to OAT stabilization and ways to reduce these barriers, such as outreach and collaborating with local pharmacies.
- Apply trauma-informed, patient-centred communication strategies to build trust during brief clinical encounters.
Lineup
In this episode, you’ll hear:
- [3:25] – Marjory Ditmars, Guest – Nurse Practitioner, Heatley Community Health Centre
- [15:28] – Dominik, Guest – Person with lived experience of opioid use disorder and treatment
Clinical Pearls
Here’s what listeners can take away from this episode:
- Prioritize building the relationship with the patient in the first visit and frame care as a partnership between the provider and client.
- Allow enough time for OAT initiation with longer appointment slots or flexible scheduling.
- Leverage community resources and partnerships like pharmacies and outreach teams to help connect with patients who are unhoused or hard to reach.
- Understand that what works for one patient may not be the best fit for another, and consistent check ins and listening can help a patient find the OAT that is best for them.
- Address myths about OAT to ensure the patient has evidence-based information about the medication.
Resources
Videos
- Starting Opioid Agonist Treatment (OAT) in Primary Care: A Primer. BCCSU. 2025. https://www.youtube.com/watch?v=hAnRyzUYqAw Accessed February 19, 2026.
- Caring for People Who Use Opioids: How to Get Started. BCCSU. 2024. https://www.youtube.com/watch?v=WrP0x0KzS34 Accessed February 19, 2026.
- RN/RPN Updates to A Guideline for the Clinical Management of Opioid Use Disorder – Guideline and Decision Support Tool Updates. BCCSU. 2023. https://www.youtube.com/watch?v=BrtsIjLKDSc Accessed February 19, 2026.
- Provincial Webinar: Updates to A Guideline for the Clinical Management of Opioid Use Disorder. BCCSU. 2023. https://www.youtube.com/watch?v=HGU-LBibC4Y Accessed February 19, 2026.
Supports for care providers
- BC Centre on Substance Use. POATSP Education and Training Pathway https://www.bccsu.ca/provincial-opioid-addiction-treatment-support-program-poatsp/
- Opioid Treatment Access Line https://helpstartshere.gov.bc.ca/blog/find-same-day-care-opioid-addiction
- Opioid Agonist Treatment Clinics Accepting New Patients https://www.bccsu.ca/wp-content/uploads/2026/01/OAT-Clinics-Accepting-New-Patients.pdf
- 24/7 support line https://www.bccsu.ca/24-7/
Reports, statistics, and guidance
- British Columbia Centre on Substance Use. A Guideline for the Clinical Management of Opioid Use Disorder: 2023 Update. Published December 2023. https://www.bccsu.ca/wp-content/uploads/2025/09/BC-OUD-Treatment-Guideline_2023-Update2.pdf Accessed June 5, 2025.
- British Columbia Centre on Substance Use. Buprenorphine/Naloxone (Suboxone) To Go: Traditional Initiation. Updated July 2023. https://www.bccsu.ca/wp-content/uploads/2023/07/Suboxone-to-go-traditional-initiation-v5.4.pdf Accessed February 19, 2026.
- British Columbia Centre on Substance Use. Buprenorphine/Naloxone (Suboxone) To Go: Low‑Dose (Micro‑dosing) Initiation. Updated July 2023. https://www.bccsu.ca/wp-content/uploads/2023/07/Suboxone-to-go-low-dose-initiation-v4.8.pdf Accessed February 19, 2026.
- British Columbia Centre on Substance Use. Methadone Clinical Summary Chart. Published September 2020. https://www.bccsu.ca/wp-content/uploads/2020/09/Methadone-Chart.pdf Accessed February 19, 2026.
- British Columbia Centre on Substance Use. Patient Assessment for Opioid Agonist Treatment. Published August 2017. https://www.bccsu.ca/wp-content/uploads/2017/08/Patient-Assessment-for-Opioid-Agonist-Treatment.pdf Accessed February 19, 2026.
- British Columbia Centre on Substance Use. Decision Support Tool: RN/RPN – Buprenorphine/Naloxone and Extended‑Release Buprenorphine. Published October 2024. https://www.bccsu.ca/wp-content/uploads/2024/10/DST-RN-RPN-Buprenorphine-naloxone-Extended-release-Buprenorphine.pdf Accessed February 19, 2026.
- British Columbia Centre on Substance Use. Decision Support Tool: Certified Practice – Slow‑Release Oral Morphine (SROM) and Methadone. Published November 2023. https://www.bccsu.ca/l/wp-content/uploads/2023/11/DST-Certified-Practice-SROM-Methadone.pdf Accessed February 19, 2026.
- British Columbia Centre on Substance Use. LOUD in the ED: Clinical Decision Support Tool. Published November 2020. https://www.bccsu.ca/wp-content/uploads/2020/11/LOUD_ED-Clinical-DST.pdf Accessed February 19, 2026.
Articles and books
- Bruneau J, Ahamad K, Goyer MÈ, et al. Management of opioid use disorders: a national clinical practice guideline. CMAJ. 2018;190(9):E247–E257. doi:10.1503/cmaj.170958
- Yan R, Kurz M, Guerra-Alejos BC, et al. What is the ideal time to begin tapering opioid agonist treatment? A protocol for a retrospective population-based comparative effectiveness study in British Columbia, Canada. BMJ Open. 2024;14(4):e083453. Published 2024 Apr 29. doi:10.1136/bmjopen-2023-083453
Credits: Clinic ambient sounds recorded by David Ball in Heatley Community Health Centre before opening to the public