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October 2013
IN THIS ISSUE


Annual Prescribers’ Conference

November 15, 2013

This year, the format of the prescribers’ conference will be slightly different. The conference will open with a plenary session, with speakers addressing Prototyping Electronic Medical Records (EMR)-based Methadone Prescribing and the Ontario Narcotics Monitoring System (read about it on MOLTC website). After a short break, we will move into breakout sessions. There will be two sessions in the morning and two in the afternoon. Sessions include:

  • Methadone and Pain
  • Buprenorphine
  • Cognitive Behavioural Therapy
  • An Interprofessional Approach to Working with Individuals with Opioid Dependence
  • Methadone and High Risk Populations
  • Urine Drug Screening
  • Refusal Skills in a Patient-Centred Context

E-mail invitations have been sent to methadone prescribers and methadone case managers. If you have not received an invitation, please contact Tracey Marshall at 416-967-2600 or 1-800-268-7096 extension 223.

Methadone prescribers workshop

The CAMH Advanced Issues in Opioid Dependence Treatment workshop will be held on November 16th, 2013,
(the day following the CPSO Methadone Prescriber’s conference).

Register for workshop here

Agenda

7:45–8:00 - Registration
8:00–8:10 - Introduction
8:10–9:10    
Pregnancy and opioid use
Interactive presentation and case study
9:10–9:40    
Acute pain management
Brief scenarios
9:40–10:40    
Drug interactions
Interactive case study
10:40–11:00 - Break
11:00–12:00    
Poly-substance use
Interactive case study
12:00–12:30    
Concurrent disorders
Brief scenarios
12:30–1:00 - Q & A
 

Methadone Q&A

Q. How often do I need to reassess a patient during maintenance treatment?

A. Patient visits are typically once a week to once a month during maintenance treatment. Most patients benefit from ongoing weekly counselling sessions with their prescribing physician. These may be continued as long as they are considered to be beneficial to the patient. Three scenarios are presented below:

Weekly visits are recommended:
  • Ongoing dose increases during maintenance treatment.
  • If the patient is tapering the dose, and well known to the physician, a weekly reassessment is not required and the patient can be reassessed within the typical interval of visits arranged with the patient. The patient should be advised to return to the clinic sooner if the taper is uncomfortable.
  • If the patient is on carries and provides a urine test that shows positive for illicit substances typically tested, the patient should be reassessed within one week of the positive sample to reassess carry privileges. The remaining script should be cancelled.
  • If the patient is typically seen once every 2–4 weeks with weekly urine testing the urine should be interpreted within 7–10 days so effective contingency management can occur and appropriate weekly office visits can be arranged when a slip or relapse occurs.
Weekly visits can be useful:
  • If a patient is in the process of acquiring take home doses of methadone, weekly physician assessments are useful to assess how the patient is doing with carries and establish effective contingency management. If the patient can only be seen every 2 weeks, weekly physician visits should be arranged in the event of a slip or relapse to effectively manage take home doses of carries for safety reasons.
  • If the patient is interested in weekly take home doses, visits can be useful for reinforcing abstinence and effective relapse prevention counselling.
Less frequent visits can occur:
  • A patient who has no take home doses of methadone and who is well known to the physician can be seen less frequently (every 2–4 weeks) if they express no interest in acquiring take home doses, or receiving counselling.
  • A patient well known to the physician who is on full take home doses who is consistently abstinent can be seen once a month if the urine requirement has been met based on guidelines.
  • In rare circumstances, when the patient lives out of town, less frequent visits than once a month may occur to maintain treatment retention. A second opinion can be useful here.
Q. I have a transfer patient who is on full carries. Can I continue the full carries upon transfer?

A. For all transfer patients, a discussion between the previous prescriber and the current methadone provider can be useful especially regarding patients who have take home privileges. Information should be obtained and documented regarding previous urine drug screen results, and, whether the previous provider followed the 2011 College guidelines with regard to acquiring the patient's take home doses, and urine collections.

Questions should also be asked about any history of carry misuse or tampered urine samples. If the physician is satisfied that the guidelines were met with regard to the present carry privileges, the carries should be continued. Carries need to be reassessed and appropriately reduced if the guidelines were not met.











Word from the Chair
The College undertakes regular reviews of all its policies. The Telemedicine policy is currently under review and a Policy Working Group has been struck to undertake this work. As part of the review, the Working Group will consider the following key issues:

  • Quality of care
  • Establishment of doctor/patient relationship
  • Privacy and security of patient information
  • Motivating factors
  • Intersection with other CPSO policies

It is anticipated that a revised Telemedicine policy will be considered by Council next year. I encourage members to review the draft policy when it is released for consultation and provide feedback to the Working Group. All College policies are posted on the College website for consultation before they are finalized by Council. See policy consultations.

The current Telemedicine policy articulates expectations for physicians practising telemedicine. This includes the expectation that physicians

  • use technology that is of sufficient quality to enable the physician to provide quality care, and
  • ensure that patient information remains confidential.

One way to meet these expectations is by conducting telemedicine sessions within a facility accredited by the Ontario Telemedicine Network (OTN). Current information suggests that other technologies, such as Skype, do not provide information security features that would protect the confidentiality of patient information. For this reason, methadone prescribers who delegate methadone administration to another regulated health professional are encouraged to use the OTN when assessing/treating patients remotely.




Patient Forum highlights issues of particular interest to methadone patients.

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