Responding to Alberta’s Crisis
Primary health care has been identified as a source of support and solution for the volume of Opioid Dependent (OD) patients that are stable and want to transition to care in the community. Alberta Health and Alberta Health Services are working on short-term, moderate-term, and long-term solutions for the Opioid Crisis and has invited the ACFP to take part.
- Alberta Health – http://www.health.alberta.ca/health-info/opioid-response.html
- AHS – http://www.albertahealthservices.ca/services/odp.aspx
- CPSA – http://www.cpsa.ca/physician-prescribing-practices/
ACFP Opioid Crisis Response Task Force was struck in late December 2016 and it has been active ever since. Eleven family physicians have stepped up to work closely with our partners and to gather information on related CPD opportunities, supports, and new initiatives to better equip our members and colleagues in primary care.
- Dr. Fred Janke, Chair (Sylvan Lake)
- Dr. Justin Balko, Edmonton
- Dr. Srini Chary, Calgary
- Dr. Laura Evans, Calgary
- Dr. Ted Findlay, Calgary
- Dr. Bonnie Larson, Calgary
- Dr. Jazmin Marlinga, Calgary
- Dr. Tally Mogus, Edmonton
- Dr. Jovita Ojadi, Red Deer
- Dr. Jennifer Walker, Edmonton
- Dr. Monica Wickland-Weller, Edmonton
- Ms. Terri Potter, ACFP Executive Director
The Task Force is comprised of a variety of family physicians working in high risk communities, chronic pain management, palliative care, comprehensive family practice and emergency rooms. It is the vision of the Task Force to advocate and develop strategies for minor adjustments in provision of services to drastic systemic changes that will support better and more comprehensive care for their patients and, ultimately, reverse the trajectory of the opioid crisis.
The Opioid Recommendations document comments on eight areas that can influence the care of patients with chronic pain, on opioid treatment, with opioid dependency, or opioid use disorder. On each page, there are five patient profiles representing an increase in risk, complexity, and level of care needed. We ask that you please consider the following recommendations based on evidence, experience, and dedication of family physicians who serve patients in this realm.
Help your patients be partners in their own safe care. Share these new opioid safety fact sheets with patients to help them learn about side-effects and risks, how to take the medicine safely and when to talk to you about their treatment.
- Opioid Safety for Patients with Acute Pain
- Opioid Safety for Patients with Chronic Pain
Developed jointly by the Alberta College of Pharmacists, Alberta Health Services, Alberta Medical Association, College & Association of Registered Nurses of Alberta and College of Physicians & Surgeons of Alberta.
- As the voice of Canada’s doctors, the CMA remains concerned about the potential harms of opioids, including dependence, overdose and death. While opioids continue to play an important therapeutic role for legitimate purposes, the prescribing of opioids must be done in a manner that is based on evidence, and includes careful assessment and monitoring.
- The CMA has been partnering with other key national organizations on the Pan-Canadian Collaborative on Education for Improved Opioid Prescribing. Together, our aim is to assess and gather evidence-based educational programming for health care professionals and develop proposals to help address gaps in knowledge for the management of pain.
Opioid Management Resources
- The College of Family Physicians of Canada (CFPC), as part of the Pan-Canadian Collaborative on Education for Improved Opioid Prescribing, and in response to Health Canada’s 2016 Joint Statement of Action to Address the Opioid Crisis, is partnering to provide educational resources for opioid prescribers. The Collaborative aims to address the harms associated with prescription opioids—including addiction, overdose, and death—while ensuring Canadians have timely and appropriate access to optimal treatments for acute and chronic pain.
- The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, developed by the Michael G. DeGroote National Pain Centre at McMaster University, will assist health care providers in making practice decisions about the safe and effective use of opioids for chronic non-cancer pain management.
- This guideline will assist family physicians in making practice decisions regarding the safe and effective use of opioids for chronic non-cancer pain management. It aims to keep patients safe from the potential harms of opioids while recognizing the therapeutic benefits of these medications.
Newly Released by the CPSA: Effective as of April 1, 2017 – Opioid crisis prompts new prescribing rules for high-risk drugs
Alberta physicians will need to meet new rules for prescribing high-risk drugs like opioids, benzodiazepines, sedatives and stimulants starting April 1, 2017.
Approved today by the CPSA Council after extensive consultation with physicians, patients and stakeholder organizations, the new Prescribing: Drugs with Potential for Misuse or Diversion standard of practice puts more checks and balances in place to improve prescribing and enhance patient safety.
Being cautious in initiating patients on these drugs, making sure the patient understands the significant risks of the medication, checking the patient’s medication history before writing the prescription and being able to justify prescribing decisions with documented patient assessments are some of the general requirements.
There are also specific safeguards for prescribing long-term opioid treatment for patients with chronic pain.
The standard does not prevent physicians from prescribing opioids when appropriate, or continuing opioid treatment for patients who are dependent.
- The objective of this guideline is to provide clinical recommendations for the initiation, maintenance and discontinuation of buprenorphine/naloxone
maintenance treatment in the ambulatory treatment of adults and adolescents with opioid dependence in Ontario.
- The guideline intends to contribute to education of practitioners regarding opioid prescribing, improved patient access to treatment for opioid dependence, and safe prescribing and dispensing of buprenorphine/naloxone.
- This evidence-based clinical practice guideline was developed by a multidisciplinary committee, and included specialists in the field of addiction medicine, family medicine and pharmacy.
- A systematic review of the literature formed the evidence base for this guideline, and recommendations were assigned levels of evidence and grades of recommendations based on those developed by the Canadian Task Force on Preventive Health Care.
National Pain Centre – McMaster – Safe and Effective Use of Opioids for Non-Cancer Pain – Practice Toolkit
This toolkit includes:
- A collection of e-practice tools for use before prescribing, to select the right opioid and titrate effectively and to monitor for safety and effectiveness and for tapering.
- There are also patient handouts, agreements, risk assessments
- The Opioid Manager which is a point of care tool for providers prescribing opioids for chronic non-cancer pain and is based on the Canadian Opioid Guideline
The 2010 Full Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain
Opioid medications are used to treat pain. Opioids are also known as narcotics. In recent years more and more Canadians are using opioids, and research indicates that we are now the world’s second largest consumer of opioids. Along with this increased use of opioids there has also been a corresponding and alarming increase in the harm from opioids.
ISMP Canada is the leading medication safety organization in Canada. Through our ongoing analysis of medication safety incidents, we have found that opioids are frequently associated with harmful consequences-including death-when they are prescribed, used or administered incorrectly or in error.
In response, we have created an Opioid Stewardship Program to help people to become better informed about opioids and to help reduce and prevent harm. This web page has been developed to provide members of the public and health care practitioners with useful and accurate information regarding opioids.
Sometimes the best of intentions lead to devastating consequences. Canada and the U.S. are the two highest consumers of prescription opioids even though we don’t have good evidence that they are effective for chronic pain. Since there are many di¬fferent opioids used for the same purpose, we use morphine equivalence to compare how strong they are.
The BC Centre on Substance Use (BCCSU) is a provincially networked organization with a mandate to develop, help implement, and evaluate evidence-based approaches to substance use and addiction.
Until June 5, 2017, this guideline is provided for educational purposes. For clinicians wishing to prescribe buprenorphine/naloxone and/or methadone please refer to the College of Physicians and Surgeons of BC’s “Methadone and Buprenorphine: Clinical Practice Guideline for Opioid Use Disorder.”
After June 5, 2017, this guideline will become the provincial guideline for the province of British Columbia
This Opioid Dependence Treatment Core 2 month/5 module Virtual Course is the foundation of the Opioid Dependence Treatment Certificate Program. In this core course physicians, nurses, pharmacists and counsellors/case managers learn skills and review guidelines for effective and safe management of clients receiving methadone or buprenorphine maintenance treatment for opioid dependence. The course is designed to promote interprofessional collaboration among the health care team involved in opioid dependence treatment.
$ 1,100.00 Physician
$ 950.00 Pharmacist / Other Health Professional
PLUS 5% GST