Oct 13, 2016

Training Key to Ending Opioid Epidemic

Pills emerging from bottle.

Liam Mitchell

Pills emerging from bottle.

With the opioid epidemic spiraling out of control, attention is turning to the need for greater physician training on the subject. In 2014, more than 700 people died in Ontario from opioid-related causes, making it the third leading cause of accidental death in the province. That is a 266 per cent increase since 2002.

The Ontario Government announced a new comprehensive opioid strategy on October 12, which among other things aims to develop new, evidence-based training modules and academic programs in conjunction with educational institutions that will provide modernized training to all health care providers who prescribe or dispense opioids.

For the past four years, the University of Toronto has offered an innovative and award winning course for physicians and other health care providers on the safe prescribing of opioids. By the end of 2016, 480 participants will have completed the program offered through Continuing Professional Development in the Faculty of Medicine.

Dr. Abhimanyu SudDr. Abhimanyu Sud, the course’s director and a Lecturer in the Department of Family and Community Medicine, explains the focus needs to be on delivering effective education, not simply more of it.

“There is a huge demand from physicians for better education on prescribing opioids. You can see genuine worry about how to deal with this issue. But we should use the best educational methods available to deliver that information,” said Sud.

The U of T course is delivered through a hybrid of online learning and in-person training. It begins with three live webinars that allow learners to respond in real time to questions posed by course instructors. Participants build their base level of knowledge on topics like the assessment of chronic pain, details about opioids themselves and then review complex case studies. That is capped by a one-day workshop where participants roleplay scenarios they might confront in their practice, such as assessing for addiction. The mixture allows for broad access to the content, but retains its interactivity that ensures lessons are understood and retained by learners.

Sud, who is a family physician with a specialized practice in chronic pain, initially came upon the field by surprise.

“I found that when I came out of medical school, I really hadn’t received a lot of training in prescribing opioids. And it was at a time when there was a shift from broadly prescribing opioids for treating chronic pain because we thought they were harmless, to starting to see the negative consequences. We were all looking for clearer information and more guidance,” he said.

A large part of that guidance came in 2010 when the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain were first released. A new set of guidelines is expected to be released in 2017.

“Our participants get a thorough understanding of the guidelines, which forms the basis of our course. It’s a complex document, so we walk them through it to ensure they have the confidence of what it says and how best to use it,” he said.

The course is offered three times per year with the next session beginning in January 2017.

While the vast majority of participants are family doctors, the course has drawn other medical specialists as well as nurse practitioners and addiction workers from across Canada. Five faculty members are helping to lead the course and plans are underway to offer the in-person workshops outside of Toronto.

“Our aim isn’t just to impart knowledge, but we really want to change how people conduct their practice. When we see practices change, that’s when we know we’re having an impact,” said Sud.