Dialogue Volume 13 Issue 4 2017 - Page 55

PRACTICE PARTNER or sold to others. Daily dispensing is also a powerful motivation for stopping drug use; take-home doses can be initiated and gradually increased when the patient consistently reports no illicit drug use and urine drug screens are consistently negative. Take-home doses of a few days or a week can be given early in treatment if daily pharmacy attendance is difficult because of work or family obligations, limited mobility, or lack of transportation. Take-home doses should also be considered in patients who only use oral opioids, who only get opioids from a single source, and who are not using alcohol or other drugs problematically. Patients who have stopped using unauthorized drugs for several months or more can attend their pharmacy once a week for one observed dose and are dispensed six doses medication to take home. Extremely stable patients can pick up 2–4 weeks of medication at a time. Urine drug screens should be done at each office visit, either through point-of-care immunoassay strips or by chromatography. A urine screen with unexpected results, such as opiates or illicit drugs, should prompt a discussion with the patient. Patients should be seen every 1–2 weeks at the be- ginning of treatment, and every month thereafter for the first year. At each visit, the physician should ask about substance use, mood, and function. Ontario. www.cpso.on.ca • Medical mentoring for addictions and pain. Ontario College of Family Physicians. http://ocfp.on.ca/cpd/collaborative- networks/mmap • Project ECHO Ontario Pain: Chronic Pain and Opioids www.echoontario.ca/Echo-Clinic/Chronic-Pain.aspx • Project ECHO Ontario Pain: Mental Health and Addictions Conclusion www.echoontario.ca/Echo-Clinic/Mental-Health-and- Buprenorphine is a safe and effective treatment for opioid use disorder, and an important part of a com- prehensive public health strategy to combat the opioid crisis. It is considered to be the best choice for opioid replacement therapy today and doctors are encour- aged to seek further guidance in order to become more comfortable prescribing it. When used appropriately and effectively, buprenorphine can save lives. MD Resources • Prescribing Drugs Policy, College of Physicians and Surgeons of Excellent resources are available to help Ontario physi- cians prescribe buprenorphine. The Centre for Addic- tion and Mental Health has produced guidelines on buprenorphine prescribing and holds an on-line and in person course several times per year. MMAP and Project ECHO provide long-distance clinical support. Addictions.aspx • Buprenorphine-assisted treatment of opioid dependence: an online course for front-line clinicians. Centre for Addiction and Mental Health, 2012. www.camh.ca/en/education/about/ AZCourses/Pages/BUP.aspx • Buprenorphine/naloxone for opioid dependence: clinical practice guideline. Centre for Addiction and Mental Health, 2011. www.cpso.on.ca/uploadedFiles/policies/guidelines/ office/buprenorphine_naloxone_gdlns2011.pdf • Essential Clinical Skills for Opioid Prescribing. Institute for Safe Medication Practices Canada, 2017 www.ismp-canada.org/ download/OpioidStewardship/Opioid-Prescribing-Skills.pdf • Safe opioid prescribing and managing opioid use disorder: A pocket reference for primary care providers. Women’s College Hospital, October 31, 2017. www.porticonetwork.ca/ documents/324069/365598/PCP+pocket+guide/279a0ded- d3a3-4173-9f5c-52c6190baab5 ISSUE 4, 2017 DIALOGUE 55