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Opioid Crisis Management is an area of increasing importance as the need to access and use information for clinical problem solving and health system management grows. Balancing the interests of key stakeholders including patients, providers, vendors, and legislators can be challenging. This Community is a space to share resources & connect with others interested in improvements within the realm of opioid crisis management in healthcare settings. (Note that since this is a public space, posting confidential information is not recommended). Browse our resources to see case studies, tools, and articles that might help generate some ideas for implementation within your organization. Share your thoughts and expertise, and ask questions to join the conversation – you can also upload additional resources here.
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Dalla Lana School of Public Health Leadership Series: Tue, 1 May 2018 5:30 PM – 8:30 PM EDT
Supervised injection services are critical, evidence-based public health interventions that save lives daily, but are Toronto's four sites enough? Should Canada join countries like Portugal in decriminalizing drug use to help overcome the stigma associated with addiction and improve community health? Registration Information for this free event: https://www.eventbrite.ca/e/decriminalizing-opioids-and-other-drugs-in-canada-tickets-44647411610
Current situation... I am in a working group looking to properly treat addiction and withdrawal from opioids among this patient population.
Where I want to go... How do I address treating opioid addiction and withdrawal among patients admitted to our mental health department?
Help I'm looking for... I am looking for more information regarding the various treatment options available.
Robert Ames Okay. Here is general article regarding treating opioid addiction: https://www.colleaga.org/article/opioid-crisis-treating-addiction. I can help you find more information, would you be able to tell me where you need more help?
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Dr. Casey Adams Sure, I’m looking to find some more information regarding the process from assessment right through to treatment of addiction situations. Would you have anything that specific?
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Robert Ames I think so -here is some information on the opioid withdrawal scale: https://www.colleaga.org/tools/clinical-opiate-withdrawal-scaleand here is an article explain how to recognize and treat opioid addiction: https://www.colleaga.org/article/opioid-crisis-harm-reduction-strategies. Moreover, here is a guideline for prescribing opioids for pain that may be of further interest: https://www.colleaga.org/tools/cdc-guideline-prescribing-opioids-chronic-pain
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Dr. Casey Adams Thanks! I’m looking for treatment methods. Would you have an example of medication-based treatment protocols?
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Robert Ames Yes, here are some general articles regarding medication-based treatments: https://www.colleaga.org/article/medication-assisted-treatment-opioid-dependence-and-addiction and https://www.colleaga.org/tools/guidelines-psychosocially-assisted-pharmacological-treatment-opioid-dependence. Additionally, here is some more information regarding naloxone that might be of interest for you: https://www.colleaga.org/article/what-naloxone
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Dr. Casey Adams Thanks! I’ll be in touch for more information if needed.
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WEBINAR: Workplace Safety and Prescribed Medications in Chronic Pain Patients
Thu, Mar 8, 2018 2:00 PM - 3:00 PM EST Employers are obliged to provide a safe work environment for employees. Unions are concerned for the safety of their members while at work. Assisting workers in achieving a safe and sustainable return to work after illness or injury has always been an appropriate goal of treatment. However, North American workplaces are increasingly challenged with how to address prescription and over-the-counter medication use by employees, while ensuring a safe working environment, given the dramatic increase in the number of prescriptions written by physicians in recent years. Link to register: https://www.wwdpi.org/Webinars/Pages/Webinar.aspx?wbID=172
Course in Understanding Stigma
https://moodle9.camhx.ca/moodle/?lang=en Courtesy the Mental Health Commission of Canada and CAMH.
Vincent Fernandez Hi Dan, here's a great tool on Substance Use Disorders: A Guide to the Use of Language, which draws attention to the terminology that currently causes confusion and perpetuates stigma. https://www.colleaga.org/tools/substance-use-disorders-guide-use-language
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Erin Gilbart Great find - it is important that we identify potential language and behaviour that may be perceived as stigmatizing.
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Current situation... I'm a physician from Toronto, that is looking for ways to integrate opioid crisis combative efforts into my practice.
Where I want to go... I'm interested in prescribing practices for patients with non-cancer pain.
Help I'm looking for... What kind of guidelines are available for prescribing to these patients?
Robert Ames Hi Joan, the BC Centre on Substance Use recently released their guidelines for Injectable Opioid Agonist Treatment for Opioid Use Disorder that you might find helpful
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Robert Ames
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Robert Ames https://www.colleaga.org/tools/bccsu-guidance-injectable-opioid-agonist-treatment-opioid-use-disorder
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Vincent Fernandez Similarly, the CDC published a guideline for non-cancer opioid treatment: https://www.colleaga.org/tools/cdc-guideline-prescribing-opioids-chronic-pain
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Sandra Ochwat Prescription drug monitoring programs often go hand in hand with prescribing practices as a harm reduction strategy, here are the CCSA's Prescription Drug Monitoring guidelines
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Sandra Ochwat https://www.colleaga.org/tools/ccsa-prescription-monitoring-programs-canada-best-practice-and-program-review
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Joan Polzin Thanks for all the information everyone. Building off my original question, is there any evidence of programs implemented to combat the opioid crisis that have demonstrated effective results?
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Sandra Ochwat Sandra Ochwat: Hi Joan, please see Oregon's strategy to combating the opioid crisis: https://www.colleaga.org/tools/oregons-strategy-confront-prescription-opioid-misuse-case-study
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Michiko Nakamura The Opioid Manager is a tool you can use to manage chronic non-cancer pain among primary care patients, check it out here https://www.colleaga.org/tools/opioid-manager
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Thanks Robert for the great post!
Here's a tool worth checking out:
How is the opioid crisis changing the role of policing?
How can front-line officers be better equipped to deal with this crisis?
Sandra Ochwat Hi there, George Valerio posted a case study of an Ohio's police department alternative approach to the opioid crisis: https://www.colleaga.org/case-study/ohio-police-change-approach-addiction-people-need-help-not-jail
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Vincent Fernandez Additionally, this tool provides recommendations on preventing overdose deaths through law enforcement https://www.colleaga.org/tools/unprecedented-opioid-epidemic
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Michiko Nakamura Here are 10 opioid crisis actions for law enformcement: https://www.colleaga.org/article/10-opioid-crisis-actions-law-enforcement
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Opioid Precribing Practices
I’m looking for more information regarding prescribing practices to get an idea of how these policies contribute to the opioid crisis.
Sandra Ochwat Hi Michiko, in 2016 the CDC published their guidelines for prescribing opioids for chronic pain. https://www.colleaga.org/tools/cdc-guideline-prescribing-opioids-chronic-pain
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Robert Ames Hi Sandra, you can start by using this opiate treatment program directory tool to find treatment within the US. I’ll be on the lookout for other countries. https://www.colleaga.org/tools/united-states-opioid-treatment-program-directory
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Vincent Fernandez Here's a good link for locating methadone clinics in north america: http://www.opiateaddictionresource.com/treatment/methadone_clinic_directory
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Michiko Nakamura Here is the clinical opiate withdrawal scale: https://www.colleaga.org/tools/clinical-opiate-withdrawal-scale
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Sandra Ochwat To add to the list, the CAGE-AID tool is used to identify high risk patients at the time of assessment, https://www.colleaga.org/tools/cage-questionnaire-adapted-include-drugs-cage-aid
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Joan Polzin The Opioid Risk Tool is similar to the Clinical Opiate Withdrawal Scale in which it can be used to identify patients at high-risk of aberrant drug-related behaviours. https://www.colleaga.org/tools/opioid-risk-tool
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Opioid Manager -- Addressing the Opioid Epidemic
April 18, 2018 - 12:00 - 1:30 PM ET
The opioid epidemic is reaching crisis proportions. As many as 40% of patients treated with opioids are on a high dose that puts them at increased risk of an overdose. Yet, tapering patients off opioids is risky, difficult and time-consuming. Learn how a new Opioid Manager app makes it easier, faster and safer to taper patients on high dose opioids. Registration Information: https://www.regonline.ca/registration/Checkin.aspx?EventID=2162920
March 29, 2018 | 12:00 – 1:30pm ET - Strategies for Strengthening Opioid Stewardship: A Conversation with the NQP™ Opioid Stewardship Action Team
Registration Information: http://nqf.commpartners.com/se/Rd/Rg.aspx?807529
Current situation... We have some complex patients on our hospital unit who require pain management but we are concerned about risk of dependency associated with opioid use.
Where I want to go... Are there CPGs for pain management?
Help I'm looking for... Specifically for managing non-cancer related chronic pain
Vivek Seth Yes, recent Canadian guidelines were issued regarding the treatment of chronic non-cancer pain. Here is a link to a high-level summary of their recommendations: https://www.colleaga.org/article/summary-recommendations-2017-canadian-guideline-opioids-chronic-non-cancer-painThe Opioid Manager tool also includes more information regarding the use of these guidelines and includessome webinars you may find useful: https://www.colleaga.org/tools/opioid-manager
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Danesh Ghandi Thanks, I’m hoping to find some additional tools to prevent overdose of opioids among our patients who are at high-risk once discharged
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Vivek Seth Okay. Here is a toolkit developed by SAMHSA regarding the prevention of opioid overdose: https://www.colleaga.org/tools/samhsa-opioid-overdose-prevention-toolkit. Additionally, here is an article that you might find useful regarding the prevention of overdose: https://www.colleaga.org/article/opioid-crisis-preventing-overdose
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Danesh Ghandi Yes, that is helpful. Do you have any examples of strategies that have been implemented to encourage to prevention of opioid overdose and misuse?
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Vivek Seth Yes, here is a tool linking to a case study in Oregon where strategies were implemented to prevent misuse: https://www.colleaga.org/tools/oregons-strategy-confront-prescription-opioid-misuse-case-study and a case study on the Health Plan of California: https://www.colleaga.org/case-study/managing-pain-safely-reducing-opioid-over-prescription-partnership-healthplan-california
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Danesh Ghandi Thanks, I will take a look!
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Leadership panel discussion Addressing Opioid use in Ontario: Reducing harm, and improving care
Quality Rounds Ontario
Thursday, January 18, 2018 - Noon to 1:00 p.m. (EST)
http://healthqualityontario.cmail20.com/t/ViewEmail/i/F25A4189707729352540EF23F30FEDED/757812B6C1D0D3449A8E73400EDACAB4
Michiko Nakamura Here is the clinical opiate withdrawal scale: https://www.colleaga.org/tools/clinical-opiate-withdrawal-scale
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Sandra Ochwat To add to the list, the CAGE-AID tool is used to identify high risk patients at the time of assessment, https://www.colleaga.org/tools/cage-questionnaire-adapted-include-drugs-cage-aid
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Shlomo Amit The Opioid Risk Tool is similar to the Clinical Opiate Withdrawal Scale in which it can be used to identify patients at high-risk of aberrant drug-related behaviours. https://www.colleaga.org/tools/opioid-risk-tool
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Robert Ames Intermountain Healthcare had the same idea. They began an initiative to safely identify and reduce where opioid prescribing can be reduced. You can find out more here: https://www.colleaga.org/case-study/intermountain-healthcares-efforts-reduce-opioid-prescriptions-improve-awareness
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George Valerio Proper medical documentation can play a critical in identifying abberant health behaviours and help physicians with effective prescribing. The AHIMA released a opioid-documentation tip that can help yours and surrounding clinics in reducing opioid overdoses. https://www.colleaga.org/tools/ahima-opioid-addiction-documentation-tip-sheet
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Current situation... I'm a police officer in the Vancouver, B.C. area.
Where I want to go... Due to spikes in local opioid overdoses, I'm investigating how the opioid crisis is changing the role of policing.
Help I'm looking for... How can how front-line officers be better equipped to deal with the opioid crisis?
Sandra Ochwat Hi there, George Valerio posted a case study of an Ohio's police department alternative approach to the opioid crisis. https://www.colleaga.org/case-study/ohio-police-change-approach-addiction-people-need-help-not-jail
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Vincent Fernandez Additionally, this tool provides recommendations on preventing overdose deaths through law enforcement https://www.colleaga.org/tools/unprecedented-opioid-epidemic
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Michiko Nakamura Hi Mathilde, the Opioid Crisis has definitely required changes in how policing approaches. Here are 10 opioid crisis actions for law enforcement: https://www.colleaga.org/article/10-opioid-crisis-actions-law-enforcement
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Joan Polzin The Vancouver police department also has provided recommendations for combatting the opioid crisis: https://www.colleaga.org/article/vancouver-police-department-recommendations-combatting-opioid-crisis
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Mathilde Goddard Thank you everyone, incredible information to consider. I will be bringing this back to my team!
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Current situation... I partake in running a methadone clinic and heard that fentanyl checking services can be effective.
Where I want to go... My clinic is considering implementing new harm reduction strategies.
Help I'm looking for... Is this true? Dose anyone know anything about the efficacy of these services?
Vincent Fernandez Hi George, great question! I recently came across this article covering a fentanyl testing program implemented in B.C. you can check it out here. https://beta.theglobeandmail.com/news/british-columbia/bc-expands-street-drug-fentanyl-testing-program/articl
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Sandra Ochwat Thanks Vincent, for this useful information. I have complied together a case study on B.C.’s fentanyl drug checking services that can be found here! colleaga
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Sandra Ochwat https://www.colleaga.org/case-study/bc-expands-street-drug-fentanyl-testing-program
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Michiko Nakamura Hi George, I’m not sure what kind of outreach programs your clinic may offer, but here’s some great information on the effects of drug-checking in public places: https://www.colleaga.org/tools/ankors-2015-shambhala-music-festival-drug-checking-report
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Robert Ames Hi George, please take a look at this evidence brief provided by public health ontario: https://www.colleaga.org/tools/evidence-brief-drug-checking-services-harm-reduction-intervention
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George Valerio Great information guys, this will definitely help us make a decision moving forward, thank you.
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Robert Ames Hi Joan, the BC Centre on Substance Use recently released their guidelines for Injectable Opioid Agonist Treatment for Opioid Use Disorder that you might find helpful.
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Robert Ames
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Robert Ames
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Robert Ames You can find them here: https://www.colleaga.org/tools/bccsu-guidance-injectable-opioid-agonist-treatment-opioid-use-disorder
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Vincent Fernandez Similarly, the CDC published a guideline for non-cancer opioid treatment: https://www.colleaga.org/tools/cdc-guideline-prescribing-opioids-chronic-pain
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Sandra Ochwat Hi Joan, please see Oregon's strategy to combating the opioid crisis: https://www.colleaga.org/tools/oregons-strategy-confront-prescription-opioid-misuse-case-study
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Sandra Ochwat Additionally, here are the CCSA's Prescription Drug Monitoring guidelines: https://www.colleaga.org/tools/ccsa-prescription-monitoring-programs-canada-best-practice-and-program-review
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Great article about the reducing the risk associated with potentially harmful medications
https://www.colleaga.org/article/how-can-harm-high-risk-medications-be-prevented
Vincent Fernandez Great read, here's more information on harm reduction specific to opioid use: https://www.colleaga.org/article/harm-reduction-strategies-opioid-users
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Thanks Michiko for the post! Something to think about regarding risk factors for rebellious behaviour.
Is your home an accomplice for your rebellious teen?
Found some interesting information to highlight and think about for any educators, and others: https://www.homeadvisor.com/r/home-safeguards/
Robert Ames Hi Marielle, great question! I recently came across this article covering a fentanyl testing program implemented in B.C., check it out here: https://beta.theglobeandmail.com/news/british-columbia/bc-expands-street-drug-fentanyl-testing-program/article3693
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Sandra Ochwat Thanks Robert for this useful information, I have complied together a case study on B.C.’s fentanyl drug checking services that can be found here! https://www.colleaga.org/case-study/bc-expands-street-drug-fentanyl-testing-program
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Marielle Gordon Great information guys, this will be great for consideration as we make a decision moving forward, thanks!
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