What strategies could mitigate the risk of abrupt cessation ? Risk reduction strategies include careful opioid tapering , assessment and treatment for opioid use disorder , education on overdose risks and access to naloxone . If you have concerns about a patient ’ s opioid use , there are resources available to support you in caring for them and reducing the risks of opioid use .
Treatment of opioid use disorders : Physicians are not permitted to discharge a patient from their practice because of a suspected or diagnosed opioid use disorder . Physicians should view opioid use disorder in the same way as any other chronic health condition and treat patients with respect and compassion . The most effective treatment for opioid use disorder is opioid substitution treatment with methadone or buprenorphine / naloxone . The following approach will help ensure that patients are safely transferred to opioid substitution treatment when appropriate :
1 Inform the patient that he / she likely has an opioid use disorder , which is causing suffering and putting him / her at risk for death from overdose .
2 Explain that opioid substitution with methadone or buprenorphine will markedly improve pain , mood and function , and while waiting to start an opioid substitution treatment program , you will slowly taper the dose .
3 Reassure the patient that this will reduce the risk of overdose and will make him / her feel better , by lessening withdrawal symptoms and dose-related depression and fatigue .
4 If the patient adamantly refuses , you should inform him / her that you are obliged to act in the patient ’ s best interests .
5 Taper slowly , by no more than 10 % of the total dose per week . Taper with a long acting opioid if possible , using
If you have concerns about a patient ’ s opioid use , there are resources available to support you
Mentorship and other practice supports
• Project ECHO Ontario Pain : education program on managing chronic pain .
• Medical mentoring for addictions and pain . Ontario College of Family Physicians .
• Mentoring , Education , and Clinical Tools for Addiction : Primary Care – Hospital Integration ( META : PHI )
• Prescribing Drugs policy , College of Physicians and Surgeons of Ontario ( www . cpso . on . ca )
• Opioid manager . Toronto Rehab & University Health Network , 2015 .
• Management of alcohol use disorders , opioid prescribing , and opioid use disorders in primary care : a pocket reference for family physicians . Women ’ s College Hospital , February 12 , 2016 .
Issue 3 , 2016 Dialogue 17