Dr. Rhea MacDonald, a family physician in Inverness, Cape Breton was uncomfortable with her own opioid prescribing practices and felt she had to make some changes to deliver better care and to prescribe more responsibly.
She learned that six of her physician colleagues had similar worries, and they decided to tackle the problem together.
In collaboration with other care providers, the local RCMP detachment and the community pharmacy, the physicians developed a series of new policies consistent with the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. The policies included a patient opioid agreement for all patients prescribed opioids, random urine drug screening, replacing short-acting opioids with long-acting ones when possible, and pill counts.
Dr. MacDonald and her colleagues expected that implementing the new policies would be difficult, and planned accordingly, but the implementation went smoothly.
“We have open conversations with our patients,” says Dr. MacDonald. “We present a united front, we aren’t targeting specific people and we continue to treat pain – but we treat it differently than we did previously,” says Dr. MacDonald.
“I am not my patient’s friend, I am their doctor and I must prescribe responsibly,” she says.
Dr. MacDonald and her colleagues hope their model – known as “The Inverness Model” – will be implemented in other communities.
“Kids are dying across this country every day from accidental opioid overdose, and it has to stop,” says Dr. MacDonald. “Prescribers need to recognize their role in this problem and also realize there is something we can do about it.”
“I have never thought of myself as a leader,” says Dr. MacDonald. “I just saw a problem, and with my team, developed a comprehensive program to address this problem.”
“Learning that I can be responsible for implementing change is humbling and mind-blowing at the same time,” she says.
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