anticipated benefits of the treatment plan , including reduction of pain , prevention of overdose , and improvement in mood , energy level , and function never use opioids alone and avoid taking benzodiazepines or alcohol at the same time as an opioid . If available , use opioids at a safe injection site .
For most patients with opioid use disorder , initiate buprenorphine or refer the patient to an addiction physician for buprenorphine or methadone treatment . Both buprenorphine and methadone have been shown to dramatically reduce opioid use , crime , and overdose . Buprenorphine can be safely prescribed and managed by family physicians . If the patient refuses the treatment plan , and will not attend an addiction clinic , then taper the dose over 1-3 months , with frequent dispensing ( as often as daily ). Continue to offer primary care , unless the patient has been abusive to office staff or other patients .
Educate patients with opioid use disorder about overdose and harm prevention . All patients on opioids should be educated about overdose and harm prevention , in particular those with opioid use disorder . Several key points should be addressed :
For all patients taking illicit opioids or high doses of prescription opioids :
Obtain a take-home naloxone kit . In many regions of the country , these kits are available at no cost and without a prescription , through naloxone programs or pharmacies .
Avoid taking benzodiazepines or alcohol at the same time as the opioid .
Use a lower dose if the opioid has not been taken for several days or more . Patients on prescribed opioids should contact their doctor for guidance .
For patients who misuse opioids ( e . g ., inject , crush or snort opioids , or acquire opioids from non-medical sources ):
Give naloxone if a friend may have overdosed on opioids and call 911 . Never leave the friend alone to “ sleep it off ”.
Use pharmaceutical opioids obtained by prescription rather than illicit opioids obtained from other sources . Caution patients that opioids obtained from other sources may contain fentanyl and that other dangerous adulterants are often added to heroin , morphine , oxycodone , and even to cocaine or crystal methamphetamine . This further increases the risk for overdose and death , even for heavy and experienced users .
Conclusion Opioid prescribing and management in the community are complex issues . This report summarizes key prescribing messages that aim to minimize the use of opioids and reverse their associated harm , as well as to support community prescribers in the treatment of opioid use disorder . MD
Acknowledgements ISMP Canada gratefully acknowledges members of the expert panel who shared their expertise for the expert panel meeting , as well as the following individuals for their expert review of this bulletin
Laurie Dunn MSc BScPhm , Six Nations Family Health Team and Medication Use Management Services , Toronto , ON ; Meldon Kahan MD CCFP , Medical Director , Substance Use Service , Women ’ s College Hospital , Toronto , ON ; Pamela Leece MD MSc CCFP FRCPC , Clinical Associate , Substance Use Service , Women ’ s College Hospital , Toronto , ON ; John Pilla MSc BScPhm , Medication Use Management Services , Toronto , ON ; and Sheryl Spithoff MD CCFP , Staff Physician , Women ’ s College Hospital , Toronto , ON .
Reprinted with permission from ISMP Canada .
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Dialogue Issue 4 , 2016