Peer mentorship in opioid management: The Nanaimo E-Mentor Initiative

BC’s opioid crisis and the recent changes to the College of Physicians and Surgeons of BC’s clinical practice guidelines for opioid prescribing[1] have inspired the creation of many pain-management and opioid-prescribing resources at the local and provincial levels.[2] 

Divisions of family practice have been at the forefront of developing many of these resources, with the goal of supporting local doctors in caring for patients with addiction issues and addressing the opioid crisis in their communities. One of the most innovative division-created solutions is a help line developed by the Nanaimo Division of Family Practice to support physicians who have questions about prescribing buprenorphine-naloxone, prescribed as Suboxone and its generics.

Changes to the College’s clinical practice guidelines for opioid prescribing have simplified the prescribing process for Suboxone,[1] removing a barrier for physicians who care for patients with opioid-addiction issues. Specifically, physicians are no longer required to have an exemption to prescribe methadone prior to being able to prescribe Suboxone (or its generic versions). This means that family doctors can now prescribe Suboxone as long as they have completed a recognized buprenorphine-naloxone education program.[3] However, the prospect of providing opioid replacement therapy may be intimidating for doctors who are unfamiliar with the process.

The Suboxone Physician E-Mentor Initiative
To help local family doctors gain confidence in providing Suboxone treatment, the Nanaimo Division of Family Practice came up with a unique technological solution—the Suboxone Physician E-Mentor Initiative. This service allows physicians to ask Suboxone-related questions by texting an SMS number by typing “Suboxone” followed by their question and contact info. Texts may come from physicians who have questions before prescribing Suboxone for the first time, physicians who are already prescribing Suboxone and have a clinical or process question, or physicians who want advice on inducting patients to Suboxone themselves.

The e-mentor idea was initiated through the division’s work on a Shared Care–funded project called Empowering Family Physicians to Manage Substance Use Patients within the Primary Care Setting. An advisory team of physicians at the Nanaimo Division agreed that providing proactive support for physicians who have completed Suboxone-prescribing education best enables them to put what they have learned into practice. One of the physicians on the team, Dr Patricia Mark, asked a few of her subspecialty colleagues if they were willing to be available by phone to help physicians who are new to prescribing Suboxone. After briefly considering a model in which the specialists would provide their own phone numbers, the Division ultimately landed on a system that allows family doctors to text questions to a central virtual mobile number. One of the specialists—an e-mentor—then responds to questions within 4 hours.

Suboxone treatment referral service
The Nanaimo Division also supports physicians in caring for patients with opioid-addiction issues by providing patient referral support. 

Physicians can contact the Division for information about referring patients to local clinics to be inducted into Suboxone therapy, after which patients either return to their physician’s care or continue maintenance treatment within the clinic, depending on the referring physician’s preference. Physicians can also register with the Division if they’d like to accept new stabilized patients into their practice for ongoing Suboxone maintenance therapy.

Suboxone FAQ handout
To support physicians in making the decision to start or maintain Suboxone treatment for their patients, the Division created a straightforward handout[4] highlighting details and frequently asked questions about prescribing Suboxone. The handout uses simple language and clear imagery and answers questions such as when and how Suboxone should be administered, how it works, what its side effects and cost are, and how it compares to methadone.

Sharing resources and lessons learned
In the spirit of collaboration between divisions, Nanaimo Division is open to sharing the resources and lessons learned from their work in opioid management. The Division has created a step-by-step guide[5] for use by other divisions who may wish to set up their own e-mentor help line. Divisions are also welcome to repurpose the Suboxone FAQ for use by their members, crediting the Nanaimo Division by including the following text: “Original content was developed by and provided courtesy of the Nanaimo Division of Family Practice.”
—Susan Papadionissiou
Director, Community Partnerships and Integration, Doctors of BC

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This article is the opinion of the GPSC and has not been peer reviewed by the BCMJ Editorial Board.

References

1.    College of Physicians and Surgeons of British Columbia. Professional standards and guidelines: Safe prescribing of drugs with potential for misuse/diversion. Accessed 15 April 2017. www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf.
2.    Ross, S. Pain-management and opioid-prescribing tools and resources. BCMJ 2017;59:186-187.
3.    College of Physicians and Surgeons of British Columbia. Suboxone. Accessed 15 April 2017. www.cpsbc.ca/programs/drug-programs/mmp/suboxone.
4.    Nanaimo Division of Family Practice. Buprenorphine-naloxone: Suboxone and generics: Frequently asked questions. Accessed 15 April 2017. www.divisionsbc.ca/CMSMedia/Divisions/DivisionCatalog-nanaimo/Documents/....
5.    Nanaimo Division of Family Practice. Using a dedicated virtual mobile number (VMN) to set up a text hotline. Accessed 26 April 2017. www.divisionsbc.ca/CMSMedia/WebPageRevisions/PageRev-11443/Nanaimo_e-men....