Resource Spotlight: Opioid stewardship

April 9, 2024
Written by Mojan Fazelipour 
 
This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca

Background

Opioids are widely consumed in Canada, with increasing usage leading to notable harms. In fact, Canada ranks second globally in opioid consumption, and incorrect prescription or use frequently results in opioid harms, including death. Opioid Stewardship emphasizes strategies to ensure the safe use and monitoring of opioids. This resource spotlight aims to highlight some resources about opioids stewardship, with links to associations, guidelines and studies that help pharmacy professionals learn more about opioid prescribing and its management, along with helpful resources to share with patients. To learn more about opioid stewardship and the role of clinical pharmacists, check out CSHP’s recent clinical pearl

CSHP-Specific Resorces

Briefing and Guidelines

Canadian Medication Optimization Briefing & Guidelines: Safe Transitions of Care for Patients Taking Opioids
Within CSHP's Canadian Medication Optimization Briefings, this resource presents perspectives on patient preferences during the initiation or continuation of opioid pharmacotherapy. It offers a comprehensive guide on collecting information about an individual's opioid use, principles of opioid stewardship, and methods for identifying care gaps. Furthermore, it emphasizes the importance of seamless care transitions for patients on opioids, proposing best practices, and includes illustrative case studies.

Advocacy Initiatives

Opioid Crisis Engagement
Here, you can access a comprehensive statement that delineates CSHP's unwavering commitment to addressing the opioid crisis. The document provides an encapsulated view of our advocacy efforts, initiatives, and contributions to combat this significant challenge, capturing the essence of our consultations and commitments in this arena.

External Resources

Canadian Pharmacists Association (CPhA)
The CPhA provides an extensive collection dedicated to enhance the pivotal role of pharmacists in addressing the opioid crisis. Their compendium features evidence-based recommendations and guidelines, tailored to direct pharmacists towards optimal opioid prescription and monitoring practices. Furthermore, the CPhA emphasizes patient engagement by offering resources that elucidate the nuances of opioid therapy, allowing for informed decision-making. This collection of tools serves as an invaluable asset for pharmacists navigating the complexities of the opioid crisis. 

Here are two webinar recordings on this topic: 

The College of Physicians and Surgeons of Ontario (CPSO)
The CPSO aims to address the opioid crisis, ensuring Ontario's providers and patients use opioids appropriately. Their strategy emphasizes safe over non-prescribing, provides physicians with their prescribing data, educational resources, and feedback. To enhance quality, CPSO advocates for real-time patient medication histories, comparative prescribing data, and a provincial monitoring program. The ultimate goal is to promote safe prescribing and promptly address any deviations for both patients and providers. CPSO has developed several guidelines and tools for the appropriate prescribing of opioids.  This is one of their published articles on Dialogue magazine: opioid prescribing. They also provide a message to patients experiencing chronic non-cancer pain: A Message to Patients Living with Chronic Non-Cancer Pain.

Canadian Guideline for Opioids for Chronic Non-cancer Pain (2017)
The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain was introduced to promote evidence-based prescribing. Developed by the Michael G. DeGroote National Pain Centre and funded by Health Canada and the Canadian Institutes of Health Research, this guideline updates the 2010 version. While advisory for physicians, it isn't a regulatory mandate and focuses solely on chronic non-cancer pain, excluding acute pain, cancer pain, palliative care, and opioid use disorder treatments.

(Opioid Wisely) Choosing Wisely Canada
The opioid crisis is having devastating consequences for individuals, families, and communities across Canada. It is a complex health and social issue, and there are no simple solutions. In response, Choosing Wisely Canada has launched Opioid Wisely, a campaign that encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing. The Opioid Wisely campaign launched on March 1, 2018 with the support of over 30 participating organizations representing doctors, dentists, pharmacists, nurse practitioners, other health professionals, as well as patients and their families. Central to the campaign is a set of 20 specialty-specific recommendations for when the use of opioids should not be first line therapy. These recommendations cover 16 different clinical specialties. 

The Opioid Wisely campaign was initiated at the encouragement of the Pan-Canadian Collaborative on Education for Improved Opioid Prescribing.

The Opioid Wisely campaign also includes information resources to help patients have informed conversations with their clinicians about safe options for managing pain:

Opioid Patient Booklet
Provided by RX Files, this is a patient-friendly document summarizing questions and answers for those considering reduction or elimination of their opioid use.

Canadian Centre on Substance Use and Addiction (CCSA)
The Canadian Centre on Substance Use and Addiction (CCSA) offers a range of evidence-based resources to address the opioid crisis. They focus on both prevention and intervention, covering the entire spectrum from prescription to addiction treatment. Besides research reports and guidelines, the CCSA provides infographics to simplify data for both professionals and the public, promoting informed decisions on opioid stewardship.  The following poster, toolkit, as well as the stigma training are examples of such resources the CCSA provides.

Opioid and Pain Management
This poster delineates the role of opioids in pain management, emphasizing their use in conjunction with non-medical treatments. It also sheds light on the potential risks associated with opioid dependence and offers links to additional opioid-related resources.

Adaptation Toolkit: Co-creating a Local Resource with Caregivers Supporting a Young Person with Substance Use Disorder A comprehensive toolkit designed for healthcare professionals, caregivers, and their allies, aimed at facilitating the co-creation of a localized handbook lead by families and caregivers.
 
Overcoming Stigma Through Language
Developed by the CCSA, the document aims to facilitate conversations and heighten awareness of the stigma faced by individuals who use substances, as well as their support networks and community service providers.  
 

These following three resources also provide insight into the stigma surrounding drug use, raise awareness of its implications, and offer strategies to overcome it, thereby enhancing patient care outcomes.

Canada.ca Opioid Data
The Canadian government provides data on opioid-related harms, monitoring, and surveillance. This can offer insights into patterns of opioid use and misuse across the country.

Institute for Safe Medication Practices Canada (ISMP)
The Institute for Safe Medication Practices (ISMP) has curated a collection of sophisticated resources emphasizing opioid stewardship. Central to their offerings is an emphasis on safeguarding the prescribing, administration, and monitoring processes to abate the inherent risks of opioid utilization. A notable instrument they've developed is "The Pain Check-In". This systematic methodology facilitates precise data collection, utilizing validated instruments, which in turn affords clinicians a robust framework for patient evaluation and joint decision-making. By aiming to standardize the data acquisition process during pain-centric consultations, it addresses and rectifies the observed inconsistencies in clinical approaches. Implemented as a pre-consultation procedure, patients engage with "The Pain Check-In" through either paper-based or electronic mediums, with the data subsequently integrated into clinical documentation systems. This pre-emptive data collection subsequently equips physicians with the necessary insights for efficacious pain management deliberations. You may access both the paper and electronic versions accompanied by their guidebooks here: 

Pain BC Toolbox
Pain BC is a non-profit organization in British Columbia comprised of healthcare professionals, individuals with chronic pain, and passionate advocates. They strive to enhance the quality of life for those with chronic pain, equip healthcare providers with effective assessment and treatment tools, and serve as a central resource for healthcare decision-makers. These are two of their online resources:

  • Pain BC’s Live Plan Be: Live Plan Be, crafted by Pain BC, is a complimentary online platform designed to aid individuals at any stage of their pain experience. It encompasses four key elements: pain knowledge, evaluation tools, Brief Action Planning, and a confidential community discussion space.
  • Pain Waves by Pain BC Podcast: Pain Waves Podcast, devised by Pain BC, features insights from prominent chronic pain specialists and individuals experiencing pain. The podcast delves into the most recent research, methods, and developments in pain management. Audiences can tune into both new and previous episodes online at their convenience. 

The British Columbia Centre on Substance Use (BCCSU)
Established in 2017, the BC Centre on Substance Use emphasizes research and evidence-based strategies to improve substance use healthcare. Their three-fold approach focuses on pioneering research, enhancing addiction medicine education, and providing evidence-based clinical guidance.  Developed by the BCCSU, the Provincial Opioid Addiction Treatment Support Program  provides training to clinicians in BC to obtain their prescribing privileges. It dives deeper into different types of OAT (opioid agonist treatments) including buprenorphine/naloxone, methadone, slow-release oral morphine and iOAT. Although this free course is geared towards prescribers in BC, anyone who has an interest in OAT may take this course. Registration for this course can be found here.

Fraser Health Pain and Opioid Stewardship Mobile App
The Fraser Health Pain and Opioid Stewardship Mobile App – this year’s winning Excellence in Pharmacy Practice – Leadership project – was co-led by Dr. Karen Ng who sought to develop a novel, open-access mobile app customized to deliver opioid stewardship-focused pain management guidance and decision-support tools including medications, pain management strategies, tools, monographs, and live opioid stewardship support. Access the app by clicking here

Opioid Manager APP
Dr. Andrea Furlan and Amy Robidas (RN) have introduced "My Opioid ManagerTM (MyOM),"  a mobile app available for iOS and Android. Complemented by iBook content, this app educates chronic pain patients about pain management using opioids. Originating from the success of the clinician-targeted "Opioid Manager (TM)", MyOM equips patients for consultations, covering pain causes, opioid use, side effects, pain tracking, and safe usage tips. Developed by NetFunctional, the app's interactivity enables pain mapping, medication tracking, and pain change measurements, promoting patient safety and collaborative decision-making. However, its resources are selective, and some linked sites are outside the University Health Network's purview. Sample ECHO Didactic Recording:

Online Opioid Self-Assessment Program

This accredited self-assessment module allows participants to refine their opioid prescribing skills based on the 2017 Canadian Opioid Guideline, offering feedback through case-based questions, and suggesting tailored courses and resources to address knowledge gaps.