Pain-management and opioid-prescribing tools and resources

The College of Physicians and Surgeons of British Columbia’s new opioid-prescribing standards (Safe Prescribing of Drugs with Potential for Misuse/Diversion)[1] make BC doctors the first in Canada to be legally bound by mandatory professional standards for safe prescribing of opioids and other addictive drugs.

The College standards apply primarily to long-term opioid treatment—the prescribing of daily opioid medications on a continuous (not as-required) schedule.[1] Among other requirements, the standards state that physicians must “document discussion with patients that nonpharmacologic therapy and nonopioid analgesics are preferred for chronic noncancer pain and that potential benefit of long-term opioid treatment is modest and risk significant.”[1] This requirement creates a need for physicians to have access to resources that not only support these conversations but also provide patients with information about pain-management alternatives they can try before, in conjunction with, or when tapering off long-term opioid treatment. Doctors of BC president, Dr Alan Ruddiman, reiterates the need for such resources in his President’s Comment in the October issue of the BCMJ, encouraging a collaborative approach to integrating professional opioid-prescribing tools and resources into medical practices to ensure patient safety.[2] 

Recognizing that physicians must balance their desire to alleviate suffering with the need for safe prescribing practices, the GPSC, through its initiatives, provides a number of resources to support doctors in caring for patients with chronic pain.  

The Practice Support Program (PSP) Pain Management module
One of the most comprehensive resources currently available to assist physicians in supporting patients with chronic pain in a way that aligns with the College standards is the GPSC-funded PSP Pain Management module (www.pspbc.ca).[3] The PSP developed the module, with input from the College and Pain BC, to provide doctors with EMR-enabled diagnostic tools to help them identify, assess, and manage patients who have persistent pain, and promote self-management to improve function. To date, more than 800 doctors have completed the module. All PSP learning modules are intended for an MOA audience as well, enabling MOAs to better support physicians and provide information and resources to patients. 

Divisions of Family Practice resources
Divisions around the province have created and compiled a number of their own resources on opioid-prescribing and alternative pain-management modalities, intended to address the opioid crisis on a community level. These include clinical resources for physicians, and resources that enable patients to connect with alternative pain-management supports in the community. Some examples are as follows.

Chilliwack 
The Chilliwack Division Mini Medical School series includes a presentation on Chronic Pain (www.divisionsbc.ca/chilliwack/minimed).

Central Okanagan
The Central Okanagan Division RACE project (Rapid Access to Consultative Expertise, a Shared Care initiative) provides access to chronic pain specialists (www.divisionsbc.ca/cod/race). The RACE service is also available via telephone or app (depending on region) provincially and regionally. Visit www.raceconnect.ca or www.raceapp.ca to learn more.

Comox
The Comox Division’s website includes a Safe Opioid Practices page (www.divisionsbc.ca/comox/safeopioidpractices). The division also organized a public awareness talk on mental health and substance use issues and resources, featuring Dr Charuka Maheswaran (www.youtube.com/watch?v=UEaojUrgp3A).

Kootenay Boundary
The Kootenay Boundary Division has created a Chronic Pain Management toolkit (www.divisionsbc.ca/kb/chronicpaintool). The toolkit provides links to a chronic pain brochure, as well as pain-management resource lists for Nelson and Lower Columbia (Trail, Rossland, Fruitvale) focusing on:
•    Medical resources
•    Cognitive therapy
•    Bodywork
•    Self-management
•    Complementary methods
•    Education

Nanaimo
The Nanaimo Division provides access to general opioid and pain resources for physicians, including guidelines, assessment tools, and community resources (www.divisionsbc.ca/nanaimo/opioid).

The division also lists opioid and pain-management resources on their Clinical Resources page (www.divisionsbc.ca/nanaimo/clinical).

Other guidelines and resources
The BC Centre on Substance Use published A Guideline for the Clinical Management of Opioid Use Disorder in early 2017.[4] As of 5 June 2017 this guideline will replace the College of Physicians and Surgeons of BC’s Methadone and Buprenorphine: Clinical Practice Guideline for Opioid Use Disorder[5] as the provincial guideline for the management of opioid addiction.

Additionally, Pain BC offers conferences and training for health care providers and access to evidence-based assessment tools like questionnaires and scaling methods.[6]

A list of division resources and other pain-management and opioid-prescribing resources mentioned in this article can be found on the Divisions of Family Practice website at www.divisionsbc.ca/provincial/painmanagement. The list will be updated on a regular basis as more resources are made available.
—Shelley Ross, MD
Co-chair, General Practice Services Committee

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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 2 March 2017. www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf.
2.    Ruddiman A. Opioid prescribing: The profession and the patients we serve and support. BCMJ 2016;58:439,441.
3.    General Practice Services Committee. What we do: Pain management. Accessed 2 March 2017. http://gpscbc.ca/what-we-do/professional-development/psp/modules/pain-ma....
4.    British Columbia Centre on Substance Use. A guideline for the clinical management of opioid use disorder. Accessed 2 March 2017. www.bccsu.ca/care-guidance-publications.
5.    College of Physicians and Surgeons of British Columbia. Methadone and buprenorphine: Clinical practice guideline for opioid use disorder. Accessed 2 March 2017. www.cpsbc.ca/files/pdf/MBMT-Clinical-Practice-Guideline.pdf.
6.    Pain BC. For healthcare providers. Accessed 2 March 2017. www.painbc.ca/health-care-providers.