Dec 2018
Opioid Use Disorder
Introduction
The prevalence of opioid use disorder has been on the rise in Ontario. From 2000 to 2016, enrolment in Ontario for opioid use disorder (OUD) treatment with opioid agonist therapy (OAT) rose from 6,000 to 40,000 patients.
The Opioid Use Disorder (OUD) Tool aims to guide primary care providers through the identification and management of individuals who have problems with opioid use. It includes a step-by-step approach for initiating and maintaining OAT with buprenorphine-naloxone.
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Information
About the tool
The Opioid Use Disorder (OUD) Tool was developed to walk primary care providers through screening, diagnosing, treating and communicating with patients who have, or are at risk of developing, OUD. The tool emphasizes a stigma-free and empathetic approach that acknowledges OUD as a chronic illness requiring long-term chronic disease management.
We heard from primary care providers about the challenges associated with opioid agonist therapy, so we outlined a detailed approach that addresses key issues. Step-by-step instructions for preparing for and conducting office and home treatments are provided along with guidance for prescribing, follow-up, treatment failure and tapering.
In order to navigate difficult conversations about opioid misuse, we’ve included talking points throughout the tool that address patient education, safety, expectations and goals.
The Opioid Use Disorder (OUD) Tool was developed using the Centre for Effective Practice’s (CEP’s) integrated knowledge translation approach. This approach ensures that providers are engaged throughout the development processes through the application of user-centered design methodology. Clinical leadership of the resource was provided by Dr. Jennifer Wyman and Dr. Arun Radhakrishnan. Persons with lived experience, end-users and clinical experts were also engaged to provide feedback.
The OUD Tool is one of several clinical tools developed as part of the Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice, Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative (KTinPC).
Clinical leads
Jennifer Wyman
MD, CCFP, FCFP, DABAM, MPH
Dr. Jennifer Wyman is a family physician practicing in both primary care and addictions. Her areas of interest include the intersection of mental health and addictions, and improving models of care for people with substance use disorders. Jennifer is the Academic Lead for the Opioids Clinical Primer, a Ministry-funded online learning program for practitioners that addresses key clinical questions regarding managing chronic pain and opioid use disorder in primary care. Jennifer obtained her Masters of Public Health degree at the Dalla Lana School of Public Health with a focus on policy and practice initiatives related to addictions and Indigenous Health.
Arun Radhakrishnan
MD, CM, MSC, CCFP
Dr. Arun Radhakrishnan is a family physician with a focused clinical practice in chronic pain. He is an Assistant Professor with the Department of Family Medicine at the University of Ottawa and the University of Toronto. He is affiliated with The Ottawa Hospital and the Elisabeth Bruyere hospital and is an investigator at the Bruyere Research Institute and the Equity in Health Systems Lab. His research and education interests are in knowledge translation mentoring and digital health technologies. He has led the development of several award-winning educational programs, clinical practice tools and resources to support primary care management of chronic pain. He is a past AMS Phoenix Fellow and is currently the Medical Director of the Adaptive Mentoring Networks with the Centre for Effective Practice.
Dr. Radhakrishnan provided clinical leadership for the development of the chronic non-cancer pain topic and was offered compensation for his role.
Clinical Working Group
A clinical working group comprised of a nurse practitioner and family physicians oversaw the development of this tool. Members include:
- Ken Lee, family physician
- Mona Sawhney, nurse practitioner
- Leah Skory, family physician
Thank you to all of our members for their work!
Persons with Lived Experience Focus Groups
The CEP would like to thank the persons with lived experience who provided their knowledge and perspective for the development of this tool. We are grateful for their time and contribution.
Conflict of interest
Clinical leads received compensation for their role.
Clinical working group members received an honorarium for their participation.
Focus group and usability participants received a small token of appreciation (e.g. gift certificate).
Expert Reviewers
We also sought expert input to inform the content and would like to thank these individuals and organizations for their time and expertise.