Message from the President

Navigating the Opioid Crisis

OCFP President Dr. Glenn Brown

June 2017

Family physicians represent 68 per cent of all opioid prescribing in Ontario and, whether it’s fair or not, we are at the centre of the intense spotlight currently focused on the tragedies of addiction and overdose gripping the province.

In this newsletter, we feature a Q&A between Chair Dr. Arun Radhakrishnan and Network Mentee Dr. Leah Skory, family physicians who are members of the OCFP Collaborative Mentoring Networks.

This informative discussion highlights the multi-dimensional and complex challenges for family physicians around opioid prescribing. We know that opioid prescribing is one of multiple factors underlying a crisis that has developed over many years and, since last year, there has been a sharpened regulatory focus on unsafe prescribing. We also know that prescription of opioids is an important part of clinical practice, including in palliative care and for improving function and addressing chronic pain in certain patients.

There is no denying the devastating consequences of unsafe prescribing and, if there is good news in this scenario, it is that the approach of the broad medical community acknowledges the need for a multi-pronged and coordinated approach to addressing the issue.

We are watchful and hopeful of recent developments, including the publication earlier this year of the 2017 Canadian Guideline for Opioids for Chronic Pain, which includes recommendations for tapering and a focus on harm reduction to help clinicians evaluate or reevaluate opioid prescribing. Further, in coming months we can expect – for the first time –  provincial clinical quality standards pertaining to opioid prescribing for chronic non-cancer pain and the introduction of a province-wide opioid strategy.

Bridging evidence into practice

These are uncharted waters and family doctors face the significant challenge of making the guidelines, standards and policies “real” for their patients and practice – of bridging into their practice the evidence represented in these emerging solutions.

We at the OCFP will continue to help you navigate what will no doubt be a difficult course. An important part of this will be ongoing efforts to foster greater understanding among all stakeholders about the vital role family physicians play in pain management. At the same time, we will continue to monitor and assess developments that affect policy and rules, so that we can fully understand what they mean for our practices and patients.

Yet opioids are only a fraction of what constitutes good pain management. Pain management – often under-acknowledged in the headline-grabbing discussion of opioid prescribing – is multi-modal, including both pharmacological and non-pharmacological interventions.

The OCFP is focused on education and research as ways to support family physicians in implementing safe, effective and compassionate pain management for patients … period.

For example, our Medical Mentoring for Pain and Addictions (MMAP) Network – one of the OCFP’s two Collaborative Mentoring Networks – delivers education in a unique format based on practical support and evidence-based resources.

Through the Networks and other priority initiatives, such as our certified continuing professional development programs, the OCFP provides education around improved opioid prescribing as well as non-opioid based therapies and how to integrate them into our practice.

To be successful, our approach to managing the risks of opioid prescribing must be coordinated and comprehensive. We are encouraged by the framework that is evolving but we also recognize the depth of the matter and know that there is a vast amount of hard work to be done. By keeping our efforts firmly focused on the patients at the heart of the issue this is a challenge we are firmly committed to meeting.

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Past Messages from OCFP President Dr. Glenn Brown

March 2017 - It's About More Than Being Nice - It's About Moral Courage
November 2016 - OCFP President Dr. Glenn Brown's Installation Address