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