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Message from the Registrar: Understanding the Opioid Guidelines

October 25, 2017

Since ACP introduced our new guidelines for assessment and monitoring individuals using opioid medications on October 1, 2017, we have received feedback from frustrated pharmacy professionals and members of the public. We’re hearing your concerns and we want to provide some clarity about the guidelines themselves and why they are important.

The good news is that, for many of you, you were already performing most of the requirements in the guidelines. You establish professional relationships with your patients. You assess every individual who brings in a prescription, opioid or otherwise. You collaborate with other members of the individual’s healthcare team. And you monitor and follow up on care.

These are all vital behaviours of pharmacists.

The biggest challenge these guidelines have introduced is the requirement to document the details of each assessment and produce written treatment plans for those who are using long-term opioid therapy or those determined to be at-risk of misuse or addiction. Documentation is critical to successful treatment, whether for acute or chronic conditions. Documentation will support future decision-making by you, other pharmacy professionals, or other healthcare professionals.

Still, we have received questions from pharmacists about each of the five key requirements within the guidelines. The answer to most of these questions is: use your professional judgement. 

When treating an individual with an opioid prescription, be in the moment. Remember that pain and addiction are sensitive issues and it is important to build trust to avoid stigmatizing the patient or making them feel judged. Determine what the assessment for each individual should look like. Assessments do not come in a one-size-fits-all format. Each assessment will differ depending on the circumstances of the individual, their health status at that point in time, and their history with you.

An assessment for a chronic pain sufferer will likely feel different than an assessment for an individual who just had their wisdom teeth pulled. Use your judgement as to what questions need to be asked, what needs to be documented, and what information the individual needs to optimize their care.

We have heard concern from both pharmacists and the public about the interview questions ACP provided as a tool for the assessment process. Many of the questions are sensitive in nature and these can be difficult conversations to have. I want to stress that the tool is just that—a tool. It is not mandatory for pharmacists to use the provided questions with each individual using opioids. The tool is simply being provided to help with your assessment if you so choose. And, if you choose to use the tool, use your judgement to select which questions are most relevant to the patient and their situation.

Pharmacists and patients have also expressed concern about going through the exact same assessment process each time they get their prescription refilled. That is not the intention of the guideline. Again, pharmacists are expected to use their professional judgement. Once the initial assessment and treatment plans are completed, use future visits as an opportunity to monitor the treatment plan, see what’s changed, and follow up as needed. Simply said, add to the existing plan; don’t create a new one.

We have also received feedback from pharmacists who do not have access to Netcare and are concerned about complying with the guidelines. Reviewing a patient’s Electronic Health Record is required every time an opioid is dispensed, so it is up to the pharmacy professional to find that information. That might mean reaching out to the Triplicate Prescription Program, the prescriber, or to another pharmacy.

Remember, the guidelines were created to ensure that patients receive the most effective treatment for their condition, and to avoid adverse effects or drug-related problems. ACP does not expect all pharmacy professionals to be addiction specialists. But we do expect you to collaborate with other healthcare professionals and refer patients when appropriate.

So, take the time to visit ACP’s updated opioid webpage. There, you’ll find links to a handout to help explain the guidelines to your patients, further explanation and background, answers to frequently asked questions, and additional resources to help with your practice.

If you are in doubt about how to interpret and apply the guidelines in a specific situation, ask a peer, or contact ACP.

Greg Eberhart
ACP Registrar