Family doctors to provide much-needed opioid treatments and support

Albertans from every walk of life struggle with opioid dependency. They are your neighbours, your friends and your co-workers. They’re not just those who have struggled with chronic mental health issues or homelessness.

It doesn’t matter if opioids are prescription medications or street drugs; opioid use disorder can affect people taking either.

Consequences may include strained or broken relationships, injury, disease transmission and death.

Almost half of those whose deaths are linked to opioids are over 39 years old. Sixty per cent had a prescription from a pharmacy in the past year. In 2016 in Calgary, 88 per cent of those who died from an opioid overdose lived outside of the downtown core.

An opioid dependency can have devastating effects on individuals, their families and their communities. It is not a drug issue. It is a health issue.

That’s why the Calgary-area Primary Care Networks have introduced new resources and training for family doctors to provide increased treatment and support for their patients.

Opioids are drugs used primarily to treat pain. Some, such as codeine, morphine and oxycodone, are prescribed medications. Others, such as heroin or illicit fentanyl, can be produced or obtained illegally. Continuous use of opioids, including for medical purposes, may lead to dependence or opioid use disorder (OUD), especially if taken for an extended period.

“It’s a matter of keeping in touch with what your patients’ health needs are and responding to them. You have to recognize if you have somebody struggling with a substance use issue and then figure out what needs to happen,” says Dr. Bonnie Larson. She is a family doctor with CUPS in downtown Calgary and member of the Alberta College of Family Physicians’ Opioid Crisis Response Task Force.

“There is a huge opportunity for primary care to respond to this crisis and to do it well.”

New resources for better treatment

Through a three-year, $9.5-million provincial grant, primary care providers will be trained to treat patients and families affected by OUD.

“We are putting structures in place over the next 18 months so the medical home can meet these needs for patients,” says Dr. Christine Luelo. She’s a family doctor in south Calgary and physician lead for the Calgary Zone primary health care opioid response initiative grant. “We’re not just training how to safely prescribe. We’re building the teams needed to support these patients.”

Patients and their families need to feel comfortable speaking about opioid use with their family doctors, and know that they will get appropriate treatment and support.

Alongside training, a mentorship program matches interested doctors with experienced colleagues. Larson, for instance, runs outreach clinics in addition to her practice. She often sees OUD in her practice, and she shares her experiences with colleagues, paramedics, pharmacists and nurses. “It’s often about helping folks who take too many Tylenol 3s or have gotten in a sticky spot with pain medications.”

Talk to your doctor

“If you don’t tell your doctor you’re struggling with opioids, they can’t help you. Have that conversation,” Luelo says. “When more patients talk to their family doctors about opioids, more doctors will get the training to support their patients.”

Prevention has a role to play, too. New opioid-prescribing guidelines help to keep patients safe. Prescribing smaller doses to be taken at regular intervals is a way for pharmacists to check in with patients regularly. And doctors will closely monitor their patients to ensure the medication is meeting their needs, and to adjust accordingly.

The opioid crisis is a highly complex problem that requires a response at every level of the healthcare system — family doctors, community-based agencies, support groups, hospitals and addiction treatment programs. Not everyone who takes an opioid will become addicted, but patients who develop a dependency need understanding and treatment for underlying causes as well as the
addiction. Family doctors can be the starting point for getting help.

“Addictions are chronic relapsing diseases,” Larson says. “And they require a lifetime of therapy.”

Written by Dan James and Colleen Seto

This story appears in the latest issue of Health Matters magazine. Read the full issue here.