College responds to opioid crisis
While opioid prescribing has stopped increasing and is starting to come down in Alberta, there is still much to be done. The College is taking action on multiple fronts to guide physicians and their patients onto a safer path. Here’s how we responded in 2016.
Working with partners
Opioid Prescribing Forum
Experts in public health, chronic pain management, addiction treatment, pharmacy and law enforcement came together at a College-hosted forum to spark discussion on how to reduce use of prescription opioids for chronic, non-cancer pain. The audience included First Nations representatives, chronic pain patients, physicians and other healthcare professionals, with more than 200 viewers live-streaming from other locations. A springboard to new partnerships, the forum focused attention on these five opioid intervention strategies:
- Appropriate prescribing
- Harm reduction
- Pain management
- Addiction treatment
- Data and reporting
Out of the forum and through invitation, the College is active in these provincial and national initiatives:
- Alberta Health – Participating on the Urgent Opioid Response Team and co-chairing the Appropriate Opioid Prescribing task force.
- University of Calgary CPD and Calgary Pain Centre – Collaborating on educational opportunities for physicians who need support with opioid prescribing and tapering patients on high doses.
- Pan Canadian Collaboration on Opioid Prescribing – Participating in this national multi-stakeholder group led by the College of Family Physicians of Canada to ensure practising physicians have sufficient resources to support them in this area of practice, such as the new Canadian Opioid Guideline coming in 2017.
- Health Canada – Signed onto the Joint Statement of Action to Address the Opioid Crisis.
To reassure the public and clarify our expectations for our members, in late 2016 the College reached out to Albertans through local newspapers across the province. Our messages were clear: We care about Albertans living with chronic pain, and we are not asking physicians to stop prescribing opioids, but to prescribe responsibly. We continue to reinforce these messages whenever we have the opportunity to respond to physician, public and media inquiries.
Empowering our members
The College has changed its approach to supporting physicians in improving their prescribing practice. Rather than targeting only high-volume and high-dose prescribers, we are connecting with a much larger number of physicians who have patients on opioids. Our goal is to have a wider and deeper impact, recognizing that the best outcome for many patients with chronic pain is better treatment with non-drug therapies.
The College launched its first MD Snapshot report in December 2016, a quality improvement tool providing practice-specific information to every Albertan physician.
The inaugural report provided about 8,200 physicians with a summary of their opioid and/or benzodiazepine prescribing during a two-month period. Based on data from the Triplicate Prescription Program (TPP) administered by the College, the report also included details about patients whose prescriptions had exceeded guidelines and patients attending multiple prescribers, as well as aggregate data for comparison purposes. In a feedback survey, 66% of respondents found the report useful and 53% planned a change to their practice as a result.
MD Snapshot will continue to be a valuable tool to help physicians improve the quality of their prescribing in 2017 and beyond.
Designing Quality Blog
Physicians shared insights from the frontlines on two College-hosted blogs related to prescription opioid use in 2016: the first on the prescribing guidelines published by the Centre for Disease Control in the U.S and endorsed by College Council, and the second on alternative ways to treat chronic pain. The online discussion helped inform our understanding of the challenges our members face in managing this issue in their practices, and provided an opportunity to offer additional resources and guidance.
New Standard for Safe Prescribing
The College invited physicians, patients and other stakeholders to provide feedback on a new draft standard of practice for safe prescribing in fall 2016. Part of the discussion: specific safeguards for long-term opioid treatment for chronic pain. Feedback was robust, and will inform an updated draft of the standard to be considered by College Council in March 2017.
CPSA Registrar Dr. Trevor Theman talked about the College’s position on responsible opioid prescribing in the College’s newsletter for physicians in July 2016 and November 2016, and directed members to resources on the College website.
Monitoring and Quality Improvement
Recent data shows pre-capita prescribing of all five of the main opioid pain medications is flat or down over the past two years (overall drop of about 3 per cent).
Our efforts to improve prescribing practice include the following monitoring, intervention and education programs:
High Risk Patient Identification (HRPI) Project: In collaboration with the Alberta College of Pharmacists, the College informs physicians when a patient is taking 500 or more Oral Morphine Equivalent (OME) doses daily, has seen three or more physicians and attended three or more pharmacies in a three-month period of time – a profile that could suggest an addiction disorder. The data is supplied by the Triplicate Prescription Program (TPP). In 2016, 266 physicians received a HRPI notification letter.
3 Plus Benzodiazepines 3 Plus Opioids (3+BZD3+Opioid): Based on TPP data, physicians are notified when a patient has received three or more benzodiazepines and three or more opioids in a three month period. Chart review, education and follow-up assist physicians in improving their prescribing practice. In 2016, 361 physicians received a letter from this program.
DOME 4000: Direct intervention and mentorship for physicians with patients receiving very high doses of an opioid medication, to support them in providing safe patient care. During 2016, there were five new interventions and four completed, with 12 ongoing at year-end.
Methadone Exemption: Physicians interested in prescribing methadone to treat opioid dependence or for other uses must apply to the College for a methadone exemption under section 56 of the Controlled Drugs and Substances Act and meet specific requirements for initiating or maintaining methadone treatment. In 2016, the College issued 21 new exemptions for a total of 651 methadone exemptions, 111 for use in treating opioid dependence.
Suboxone Authorization: Buprenorphine/naloxone – trade name Suboxone® – has gained acceptance as a safer alternative to methadone in treating opioid dependence. Physicians can apply to the College for authorization to prescribe this drug after completing an online course. In 2016, 47 physicians received authorization.