Technology and the Effective Use of Opioids

Opioid Warning Image

There is an opioid crisis in Canada.  Opioids are widely prescribed to help patients manage chronic pain.  In 2015 it was reported that opioid pain relievers are used by 14.9% of the Canadian population.

According to the Canadian Pharmacist Association (CPhA), Canada has one of the highest rates of opioid use per capita in the world. In 2015, 53 opioid prescriptions were written for every 100 people in Canada (including medications used for treating opioid addiction such as methadone and buprenorphine).  For patients suffering from chronic pain opioids reduce pain and improve functionality but  they can be addictive and have been over prescribed for about twenty years.

A report on opioid poisoning  by the Canadian Institute for Health Information (CIHI) identified the following impacts:

  • Opioid poisonings result in more than 13 hospitalizations a day in Canada
  • Between 2007 and 2015, the rate of hospitalizations due to opioid poisoning increased more than 30%
  • Seniors have the highest rates of opioid poisoning hospitalizations
  • Opioid poisoning hospitalizations was slightly higher (53%) among females
  • Accidental opioid poisonings accounted for the highest proportion of hospitalizations

The Centre for Addiction and Mental Health (CAMH) stated “this crisis has it’s roots in the health care system” through inappropriate prescribing that has led to harm.  Given that the system created the problem, it’s encouraging to see some corrective action.  Last week saw the release of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, other provincial strategies include BC’s Opioid Overdose Response Strategy and Ontario’s Strategy to Prevent Opioid Addiction and Overdose.

How will all of these initiatives to correct the opioid crisis impact chronic pain patients who use opioids to manage their illness?  In Nova Scotia alone there are approximately 4,000 patients managing doses of opioids that are higher than the guidelines. Dr. Gus Grant, Registrar with the Nova Scotia College of Physicians and Surgeons stated that the new guidelines are meant to develop a plan to help those already addicted to opioids. “The patients who are on these medications right now, they need to be managed sensitively and appropriately and not ruggedly. They can’t be thrown into withdrawal. They can’t be abandoned.”  I couldn’t agree more.  So how can technology help patients who are prescribed opioids?

5 Technology Solutions for Prescribed Opioids:

  1. Digitally monitored therapy - The  Canadian guidelines list 5 recommendations for monitoring therapy of Long Term Opioid Therapy (LTOT).  Pharmacy integrated medication management programs such as Your Health Report can help patients with opioid self-management and can connect them to a care provider to support co-management of medications.
  2. Pharmacy-based support programs - Pharmacists from Nova Scotia have created the Bloom Program, dedicated to helping pharmacists treat mental health and addiction issues. Pharmacies that use integrated programs to connect their patients to their medication profile see increased effectiveness in support programs.   
  3. Patient education – the Joint Action Plan, resulting from the Pain Summit in 2016, identified “Informing Canadians about the risks of opioid use” as its first action.  Technology connecting patients to their medication profile can be a logical conduit for the transfer of validated medication information based on prescribed therapies.
  4. Drug Information System – Currently most Canadian provinces have some form of prescription monitoring program (PMP).  The use of PMPs was endorsed as an important component the 10-year strategy to address the prescription drug crisis back in 2013. These systems can flag potential abuse and monitor opioid prescribing trends to find problems in the system before they impact patients.
  5. e-Prescribing – Electronic prescriptions can make opioid use safer by making it tougher fake prescriptions and safer for opioid patients to get their medications.  In the US up to 95% of pharmacies accept e-prescriptions and over 80% of doctors have adopted e-prescribing.  E-prescribing is relatively new to Canada but Canada Health Infoway ramped up implementation in 2016.

The opioid crisis has it’s roots in the prescribing practices of physicians and the new guidelines are a great starting point for doctors and their patients dealing with a new diagnosis of chronic pain.  Let’s keep working towards safe and effective solutions for the thousands of Canadians who rely on opioids to manage their pain.