Fall 2017 eNewsletter Article: Tackling the Opioid Crisis Through Medical Education
While mainstream news sources reporting on the nation’s opioid crisis often focus on opioids that are illegally manufactured and sold, physicians and other healthcare professionals know that those prescribed legitimately for pain can also influence the misuse of opioids and result in addiction. Canada ranks only second to the United States in the per capita consumption of prescription opioids, and opioid management remains a complex area for Canadian physicians.
Guidelines and Educational Programs to Help Physicians
In light of the crisis, physicians will want to be aware of the latest evidence and have access to educational programs to help them protect their patients from potential harm. One key resource is the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, that was published by the National Pain Center at McMaster University in May. It incorporates medical evidence published since the previous national opioid use guideline was made available in 2010 and sets out recommendations for Canadian doctors in the prescribing of opioid medication.
In terms of education, Canadian healthcare professionals, researchers and educators are making efforts to tackle the issue through programs that help physicians navigate the complexities of opioid prescribing and reduce the risk of misuse and addiction.
“Through continuing medical education, physicians can feel more confident in their ability to assess a patient’s global risk from opioids and to switch, taper and discontinue opioid therapy when risks outweigh benefits.” said Dr. Abhimanyu Sud, Academic Director at the University of Toronto. “Physicians are facing a range of challenging issues from recognizing and managing opioid use disorder in patients, to how to prescribe opioids for special populations.”
Dr. Sud leads the University of Toronto’s Safer Opioid Prescribing - A Multimodal Program for Chronic Pain and Opioids. The program was originally developed in 2012-2013 by faculty at the University’s Department of Family and Community Medicine, and the recently updated version is among the first to be compliant with the 2017 Guidelines.
The Safer Opioid Prescribing program was specifically designed to address the educational gaps in chronic pain and opioid prescribing. In designing the format of the program, faculty recognized the need to make it accessible to busy physicians, especially those in rural and remote communities that have been hardest hit by the opioid crisis and typically have poorer access to high quality education. For this reason, the program consists of three webinars held in the evenings and one full-day in-person workshop.
More than 600 physicians from across the country have participated in the program to date. One of those participants, Dr. Kishore Singh, a family physician in Burlington, Ontario attested to the effectiveness of the program’s format:
“The program was well laid out and not squeezed into one day. It was done over several sessions so we had time to assimilate the knowledge. The in-person workshop at the end was particularly useful. I also learned how to use the various tools provided in the course and had hands-on practice.”
Dr. Kishore also commented on the value of the learning: “The knowledge gained was tremendous. I learned how to deal with difficult patients – how to handle them better. I left the workshop feeling better equipped and on the right path.”
To date, the workshop has been offered only in the Toronto area, but it is being expanded nationally starting next year. In 2018, it will be offered in Quebec, Alberta and Saskatchewan for the first time, through a collaboration with the Saegis Safety Institute.
“We are facing a national crisis and need to collaborate widely to expand access to evidence-based interventions.” added Dr. Sud.
Taking a Team Approach
Collaboration with other healthcare professionals to manage chronic pain is also helpful as both a preventative measure and a solution to long-term cases. Studies have shown that in trying to reduce or discontinue opioid therapy, a multi-disciplinary team that includes other professionals can substantially increase the likelihood of success. To address this, a team approach is one of the recommendations included in the 2017 Canadian Guidelines.
Teams can include a wide range of professionals depending on the situation, including pain specialists, nurses, pharmacists, physical therapists, addiction specialists and psychiatrists. Educational programs in opioid prescribing, like the U of T program, will often teach skills in communication and collaboration, and provide tools for working with other healthcare professionals to manage complex patients.
A Win-Win for Physicians and Patients
With mortalities from overdose on the rise, the societal benefits of addressing the opioid crisis through solutions such as medical education are evident. At the same time, it is also in the best interest of physicians as the management of opioids to treat chronic pain is a cause of medical-legal difficulties for Canadian doctors. By participating in in educational programs that will increase their knowledge and skills, physicians can better protect themselves and improve patient safety at the same time.
Physicians and healthcare professionals interested in learning more about the Safer Opioid Prescribing program can visit the University of Toronto’s website or the Program Details page on this website.
 Silversides A., Backgrounder: Canada’s prescription opioid crisis. EvidenceNetwork. ca [Internet]. Winnipeg (MB): University of Manitoba; 2014 Jul 31 [cited 2016 March 4]. Available from http://umanitoba.ca/outreach/evidencenetwork/archives/19635
 The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain: Recommendation 10, p. 74
 Opioids: We can do better, Canadian Medical Protective Association, 2016, p. 3. https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-meeting/com_16_opioid_We_can_do_better-e.pdf