AFHTO Events

Strategies for Opioid De-Implementation in Primary Care – Resources

Monday, June 11, 2018 YMCA GTA Central, Toronto, ON | KFL&A Public Health 221 Portsmouth Avenue, Kingston ON 10:00am - 3:00pm

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.

Slide decks, handouts, videos, and other resources from the workshop are available below.


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:

  • A deeper understanding of the opioid crisis in Ontario
  • Knowledge of what de-implementation is (and what it is not)
  • An appreciation for the value of opioid de-implementation and the role of primary care teams in advancing the provincial de-implementation strategy.
  • Evidence-based, practical approaches to safer pain management, opioid stewardship, and addiction treatment in interprofessional primary care settings.
  • Tools and partnerships opportunities that can help advance their teams’ existing opioid stewardship efforts.

Centering the Patient Perspective

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.

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

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.

Plenary Sessions

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.

Toronto Small-Group Sessions

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

Kingston Sessions

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

Tools Showcase

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

More Resources

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:



Tell us what you think!

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?

Opioid Project – Nicotine Dependence Service
Centre for Addiction and Mental Health
175 College St.
Toronto, ON  M5T 1P7

Interested in having another learning event on this topic? Want to be a part of the provincial opioid de-implementation initiative? Contact and let them know.

Want to connect with more of your peers and find out what they’re doing to improve team-based primary care in Ontario?  Join us for the AFHTO 2018 conferenceRelationship Design with Starfield in mind. Registration opens soon!