Thank you to all who participated in our June 11, 2018 workshop, Strategies for Opioid De-Implementation in Primary Care. We had a truly interprofessional audience with nearly 100 attendees in Toronto and another 50 in Kingston. Providers and leaders in team-based approaches to better pain management and opioid stewardship gathered to exchange knowledge, tools, and ideas.
|Overview||Centering the Patient Perspective||Plenary Sessions||Toronto Small-Group Sessions||Kingston Sessions|
|Tools Showcase||More Resources||Acknowledgements||Tell us what you think!|
De-implementation means stopping low-value ways of prescribing opioids and replacing them with better approaches. Low-value practices either don’t work, make things worse or have an unknown effect. De-implementation does NOT mean teams stop using opioids altogether. It could mean using lower doses of opioids, or it could mean using lower doses of other drugs and/or helping patients manage their pain in other ways.
Strategies for Opioid De-Implementation in Primary Care was an opportunity for primary care teams to learn from each other and from experts in the field of mental health and addiction about interprofessional initiatives they can start using now to help patients manage their pain and opioid use. We hope you left with a new idea to try.
Here’s what participants gained:
At this event, we introduced participants to the wisdom of several patients who have first-hand experience with pain and opioid use. Although they were unable to participate in person, they graciously permitted us to share their stories.
Tina Carr is a patient of Queen’s FHT whose experience was profiled in the Spring/Summer 2015 edition of the QFHT News. After being prescribed a daily, high dose of opioids to manage chronic pain, Tina developed an addiction to the drug and through she needed a higher dose. With the support of her Family Health Team, she has learned other ways to manage her pain, and this has allowed her to reduce her opioid use from daily to occasional. She feels better about herself and has returned to full-time work and school. Having an understanding doctor was essential to Tina’s success.
Dr. Watson didn’t undermine my pain; she offered other ways to deal with it.
Carlyn Zwarenstein is a freelance journalist and patient advocate. She has written extensively about her experience with chronic pain and opioid use. Her book, Opium Eater: The New Confessions was a Globe 100 Best Book of 2016. She has also written an op-ed for Choosing Wisely, calling for caution and compassion in opioid prescribing (and de-prescribing). She notes that for some patients, such as herself, “effective dose of an opioid is the most sensible and merciful option […], for now,” and she expresses concern about “doctors absorbing a strictly anything-but-opioids message, rather than focusing on the overall well-being of the patient in front of them.” She is cautiously optimistic about the Ontario approach to improving opioid stewardship, but she reminds us that they key to successful pain management is a constant conversation between patient and doctor. Learn more about Carlyn and her experience at carlynzwarenstein.com.
No patient should be treated as a morphine equivalent, a prevalence statistic, an addiction risk or a lawsuit [….] Better and more fulfilling communication with pain patients—who can be the most grateful of patients, not because you write them scripts, but because you are a vital partner in helping them to thoughtfully weigh the multiple factors that make difficult lives more manageable—has the potential to improve physician job satisfaction as well as patient care.
“Jen” is a composite of several patients. Her doctor believes she is an addict. She knows that she is in pain. You can read a case study about “Jen,” here. It starts with her own story; her doctor’s clinical perspective follows. This case study was prepared by Drs. Mireille St. Jean, Leah Skory, and Arun Radhakrishnan, with support from the Ontario College of Family Physicians.
Sue had never used illicit drugs until her 30s, when her doctor prescribed opioids to help manage her anxiety and pain. She became addicted to them and remained addicted for 25 years. After multiple hospitalizations for symptoms of withdrawal, she was started on methadone and has now been “clean” for 10 years. Sue shared her experience in this video from CAMH to remind us that addiction can affect anyone.
Opening Remarks | Dr. Peter Selby, CAMH.
Beyond the Stigma: An Approach to Concurrent Pain and Addiction | Dr. Andrew Smith, CAMH.
Putting the Strategies to Work – Next Steps Together | Carol Mulder, AFHTO.
Buprenorphine-naloxone for the treatment of opioid use disorder in primary care | Dr. Nikki Bozinoff, CAMH.
Mentorship Models for Family Physicians | Dr. Arun Radhakrishnan, Ontario College of Family Physicians
Non-Pharm Care of Chronic Pain | Dr. Bryan MacLeod, St. Joseph’s Care Group
Managing benzodiazepines and other controlled substances in the context of de-prescribing opioids with older adults | Dr. Jonathan Bertram, CAMH
Setting the Stage | Dr. Fareen Karachiwalla, KFL&A Public Health
A Population Approach to the Opiod Crisis in KFL&A | Rhonda Lovell, RN, KFL&A Public Health
What opioid- and pain-related services does Street Health Offer? | Travis Mitchell, Kingston CHC
Opioids and Chronic Pain: Case Studies and Personal Experience | Dr. Rupa Patel, Kingston CHC
Role of Interprofessional Health Care Providers in Opioid De-Implementation |Abigail Scott, Cynthia Leung, and Erin Desmarais, Queen’s FHT
Chronic Non-Cancer Pain Management Tool | Amanda van Hal, Centre for Effective Practice and Tara Lonergan, eHealth Centre of Excellence
Validated EMR Queries for Opioid Stewardship | Jesse Lamothe, Hamilton FHT
HARMS Program for Safer Opioid Prescribing | Dr. Ryan Patchett-Marble, Marathon FHT
Want to read the presenters’ bios or see the workshop synopses at a glance?
Looking for a list of partnered supports for managing pain and addictions? Find it here.
We thank the following organizations for their contributions to this event:
We’d love to hear your impressions of Strategies for Opioid De-Implementation in Primary Care. Did you find the presentations valuable and relevant to your team? Did you find anything surprising? What tools or ideas did you take back to your team?
Interested in having another learning event on this topic? Want to be a part of the provincial opioid de-implementation initiative? Contact firstname.lastname@example.org and let them know.