Opioid addiction is a serious issue in Nova Scotia. There are, however, a number of practical and accessible ways for doctors here to address it, says one family physician.
Primary care is an ideal starting point, says Dr. David Martell. Based in Lunenburg, he has been treating people with opioid use disorder (OUD) since 2011. Rather than refer his patients with OUD to a specialty clinic where they could face lengthy wait times, Dr. Martell treats them as part of his primary care practice.
“The provider best suited to help you with most of your health problems is the provider who knows you best,” he says. “There is no shorter wait time than ‘right now’ and no better place than where you already access the health-care system.”
There are also specific tools available to doctors, he says, such as the Opioid Risk Tool (ORT). “The use of a screening tool prior to making the decision to prescribing opioids can effectively limit the possibility of developing an addiction to less than one per cent.”
The ORT was endorsed in 2010 in the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-cancer Pain; a newer guideline was released in May. Those guidelines, which Nova Scotia doctors can access now, include an update on best practice guidelines for prescribing opioids.
“Primary care providers can also employ tools such as treatment agreements, urine drug screening and random recalls for pill counting,” Dr. Martell adds. “We also have a prescription monitoring program that can show if a person is obtaining opioids from another provider and help uncover prescribing patterns that are problematic.”
Progress is being made on Nova Scotia’s Opioid Use and Overdose Framework, he says. “A recent development was the announcement by the provincial government that overdose prevention kits will be distributed at no cost. This will directly save lives.”
Education for doctors about opioid prescribing is key, says Dr. Martell.
“Primary care providers receive almost no training in addiction and this represents a major barrier to accessing treatment,” he explains. “Training in addiction should go hand in hand with opioid prescribing privileges.”
There are courses on addiction that are available through the BC Centre for Substance Use and Addiction, available at no cost, and the Centre for Addiction and Mental Health. Nova Scotia offers The Prescriber’s Course: Safe Opioid Prescribing for Chronic Non-cancer Pain, an accredited and nationally recognized course available through the Atlantic Mentorship Network for Pain and Addiction. The network, set up in 2008, also offers peer support for frontline providers.
Ultimately the biggest change to future prescribing habits will come from providing best practice education to doctors just beginning their careers, says Dr. Martell.
“I would like to see more public awareness campaigns that fight the normalization of opioid use. I also feel it would be very valuable for providers within the province to form a community of practice around opioid prescribing to come together to learn from each other and explore best practice in opioid prescribing.”