Education

This section provides links to educational materiel for providers along with tools and resources that educate and support efforts to prevent and reduce harms associated to opioids with pain management for health providers.   

ResourceBrief description
Learning Module: Opioid Prescribing and Pain Management: Prescription Monitoring Program Overview and the Management of Acute Low Back Pain 

Accompanying slide deck
In partnership with the New Brunswick Medical Society and Choosing Wisely New Brunswick, CADTH, this module provides an overview of the New Brunswick Prescription Monitoring Program and addresses the management of acute low back pain
Opioid Wisely  Opioid Wisely provides guidance on how to have thoughtful conversations with patients to reduce the harms associated with opioid prescribing.

The site also offers pamphlets intended for patients to help them understand the role of opioids in their treatment as well as to learn about various other tests, treatments, and procedures.  
Chronic non-cancer pain management and opioid resources – CFPC  The College of Family Physicians of Canada (CFPC) chronic non-cancer pain management and opioid resources site includes continuing professional development programs and resources for family practitioners. Care providers can peruse resources and click to easily access opioid tapering templates, Q & A on short term pain, one-page OUD care pathways, chronic pain and opioid resources among many others.  
ePractice toolkit for safe and effective use of opioids for chronic non-cancer pain (McMaster University Michael G. DeGroote National Pain Center)The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain provides a comprehensive ePractice toolkit including the “Opioid Manager” and easily accessible links to a variety of other helpful tools that include among many others: “Tools to use before prescribing opiates”, “Opioid risk tool”, “Benzodiazepine taper information”.  
Questions and Answers: Prescription Opioids – Sticker and Handout Requirements for Pharmacists and Practitioners This Health Canada document provides guidance geared toward ensuring that patients who require opioids have access to them, but with the appropriate safeguards in place. It provides detail on providing patients with clear information about the safe use of opioids and the risks associated with their use.  
Pharmacist’s Virtual Communication Toolkit: Engaging in Effective Conversations About Opioids This resource provides pharmacists with tips on the three stages for engaging in conversations with patients including strategies, behaviours and sample dialogue. this virtual toolkit links to a wide range of communication tools for both pharmacists and their patients. 

Opioid misuse and opioid use disorders in primary care settings

The prescribing of opioids in the context of a pain management plan can be complex, particularly when treating individuals with histories of substance dependence and/or mental health issues. Even with the best care planning and diligent monitoring, the risk of opioid misuse and dependence cannot be eliminated. The risk of opioid use disorders developing in patients can be reduced through appropriate screening, careful opioid management plans and open and clear communication with patients and multi disciplinary team members.

The following tools and resources are intended to provide information and guidance to primary care providers in helping patients experiencing opioid misuse, or opioid use disorders within the primary care setting. 

ResourceBrief description
Canadian Medical Association Journal opioid resource page The Canadian Medical Association Journal’s search page providing links to various opioid related topics intended for primary care settings.
Canadian Center on Substance Abuse website The Canadian Center on Substance Abuse provides information on opioid use and other substance use disorders
CCSA Best Practices Across the Continuum of Care for the Treatment of Opioid Use DisordersThis is the link to the Best Practices Across the Continuum of Care for the Treatment of Opioid Use Disorders document.
CRISM National Guideline for the Clinical Management of Opioid UseLink to the CRISM National Guidelines for the Clinical Management of Opioid Use Disorder.
Government of New Brunswick Opioid webpageLink to the Government of New Brunswick Opioid page. Also details public health surveillance reports and information on Take Home Naloxone kits including an educational video intended for the public on how to administer Naloxone in the event of an overdose.  
CADTH Lecture Series. Webinar – Canada’s Opioid Crisis: The Changing Reality Between Exam Rooms and Ivory Towers (Oct 2017)On October 12, 2017, Dr. Hakique Virani, Medical Director, Metro City Medical Clinic; and Assistant Clinical Professor, Department of Medicine, University of Alberta, delivered an in-person and webinar lecture entitled “Canada’s Opioid Crisis: The Changing Reality Between Exam Rooms and Ivory Towers.”  
Health Canada’s opioids toolkit Health Canada’s toolkit on opioids provides resources to help promote awareness on preventing opioid overdoses.  
NANB opioid toolkitThis toolkit is provided by the Nurses Association of New Brunswick and offers healthcare providers and the public resources to help manage the opioid crisis.  
Safe prescribing practices for addictive medications and management of substance use disorders in primary care: A pocket reference for family physicians (Kahan, 2017a) This handbook is intended as a quick-reference tool for family physicians to assist them in implementing best practices for prescribing potentially addictive medications and managing substance use disorders in primary care.
Safe opioid prescribing and managing opioid use disorder: A pocket reference for primary care providers (Kahan, 2017b) This pocket guide is excerpted from Safe prescribing practices for addictive medications and management of substance use disorders in primary care: A pocket reference for primary care providers and aims to provide a quick-reference tool for primary care providers to assist them in implementing best practices for prescribing potentially addictive medications and managing substance use disorders in primary care. This excerpt is a guide to safe opioid prescribing and managing associated complications, including opioid use disorder  
Managing opioid use disorder in primary care: PEER simplified guideline (Korownyk, 2019). These guidelines help simplify the complex management of patients with OUD in primary care and aids clinicians and patients in making informed decisions regarding their care.

Initiating conversations with patients about opioid use disorders

When initiating conversations with patients about opioid dependence or opioid use disorders, health providers may find the following resources intended for patients helpful as complements to the provider/patient consultation.

Patient Resources/Handouts
Methadone for Opioid Use Disorder: Your Questions Answered: ISMP, CADTH & othersA patient handout with questions and answers about using methadone to treat opioid use disorder.
Buprenorphine/Naloxone (Suboxone) for Opioid Use Disorder: Your Questions Answered: ISMP CADTH & othersA patient handout with questions and answers about using Suboxone to treat opioid use disorder.

Additional resources that may be of interest

This section lists links to other relevant information and topics relating to emerging trends in opioid prescribing.

ResourceBrief description
CADTH Evidence Bundles  This easy to navigate site provides quick access to evidence bundles presented to look like topic specific reading rooms within the CADTH website. This provides the ability to browse through all related content or quickly find exactly the information needed.   Evidence bundles within this site related not only to opioids for pain management topics, but also on a wide variety of other topics useful in primary care settings.  
CIHI: Opioids in Canada  Canadian Institute for Health Information’s (CIHI) opioids in Canada webpage. This website details the outputs of the four years of targeted funding from Health Canada that establishes key metrics and publicly reports data on opioid use and harms across the country.  
CIHI: Opioid Prescribing in Canada – How are Practices Changing?  The Opioid Prescribing in Canada – How are Practices Changing? report discusses findings within the context of initiatives and guidelines aimed at reducing harms associated with prescription opioid use.  
Pain Management and Opioids – Addressing Important Challenges and Introducing a Chronic Pain and Opioids Mini Book  This resource explores evidence, clarifies some misunderstandings and discusses some best practices approaches around opioids and pain.  
eConsult eConsult provides a secure online platform for primary care providers (family physicians and nurse practitioners) to access patient specific, non-urgent specialist advice. Access to specialist advice can increase the capacity of primary care providers to manage patient care in the community. eConsult may also reduce the burden on specialist wait lists by avoiding unnecessary face-to-face specialist referrals, where appropriate. Two specialties available through eConsult are Opioid Addiction Management and Chronic Pain Management. 
Coalition for Safe and Effective Pain Management (CSEPM)  This resource provides information relating to improving integration and access to non-pharmacological pain management to reduce the prevalence of opioid prescribing in Canada and provide effective pain management tools for clinicians, and patients seeking relief from pain.

References