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Dec 2018

Opioid Use Disorder (OUD) Tool

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 Lead

  • Dr. 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.

  • Dr. Arun Radhakrishnan

    MSc, MD, CM CCFP

    Dr. Arun Radhakrishnan is a family physician with a focused practice in chronic pain and is the current co-chair of the Collaborative Mental Health Network and the Medical Mentoring for Addictions and Pain Network at the Ontario College of Family Physicians. He is also an adjunct assistant professor with the Department of Family and Community Medicine at the University of Toronto. 

    In 2013, Arun completed a Master’s degree at the University of Toronto in Health Services Research focusing on the value of information and communication technologies to enable knowledge translation activities in the areas of pain, mental health and addictions to support community physicians. His interests also include teaching and curriculum development around the integration of technology into the clinical encounter.

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.

Target End User Feedback and Expert Opinion

We also sought expert input to inform the content and would like to thank these individuals and organizations for their time and expertise.


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