Opioid Replacement Therapy 101 Introduction to Clinical Practice April 12 and 13 2018

Course Objectives:

At the end of this workshop, participants will be able to:

Have the prerequisite knowledge for initiating and monitoring patients on methadone and/or buprenorphine/naloxone.
Have developed basic decision making skills essential to providing or dispensing safe and effective opioid replacement therapy.
Appreciate the value of sensitivity, understanding and commitment in the delivery of addictions medicine in clinical or pharmacy practice.

Specific Learning Objectives:

At the conclusion of this workshop, participants will be able to:

• Identify opioid use disorder (neuroanatomy and pathophysiology of the brain’s reward system, typical clinical presentations, typical behaviours, DSM-5 criteria).
• Explain the model of addiction as a chronic disease, requiring long term management by health care professional(s) as well as mental health, spiritual and social support.
• Perform a comprehensive assessment of an individual with opioid use disorder and select appropriate treatment options.
• Recognize the unique pharmacology of methadone and buprenorphine/naloxone and participate effectively in prescriber – pharmacist collaborative care.
• Identify potential and actual drug interactions.
• Select an appropriate methadone induction dose and manage initial methadone induction, dose adjustments and early stabilization issues appropriately.
• Assess a patient’s appropriateness for carry doses, including frequent reassessment and as-needed adjustments to carry status.
• Discuss important issues in the maintenance phase of treatment, including urine toxicology, prolonged QT, split dosing, smoking cessation support and withdrawal of treatment.
• Identify special considerations in the treatment of pregnant women with opioid use disorder – in the ante-natal period, during labour and post- partum, including breast feeding.
• Examine neonatal opioid withdrawal and recognize how treatment decisions may impact withdrawal severity and overall maternal/neonatal outcomes.
• Examine the role education and advocacy plays in promoting improved neonatal/maternal outcomes and strengthening the family unit.
• Discuss special issues in the management of individuals with opioid use disorder and concurrent major psychiatric disorders.
• Discuss special issues in the management of individuals with opioid use disorder and concurrent chronic pain.
• Identify special considerations in the management of the individual with opioid use disorder and hepatitis C and/or HIV.
• Formulate a practical approach to managing insomnia in the patient with opioid use disorder.
• Discuss important safety considerations and formulate a practical approach to managing individuals with opioid use disorder who also abuse alcohol and/or benzodiazepines.
• Distinguish different models of service delivery in opioid replacement therapy including the comprehensive care model, private clinic model, community clinic model and family practice model. Compare and contrast the strengths and weaknesses of each model.
• Implement and integrate safe preparation, documentation, and dispensing of methadone in pharmacy practice.

Day 1 Agenda April 12:

8:00 – 8:30 Check In and Coffee

8:30 – 8:45 Introductions and Orientation to the Workshop (Includes pre-test)

8:45 – 09:30  A Review of Opioid use disorder and emerging inpatient and community disease patterns…..Ginette Poulin

09:30 – 10:15 Treatment approaches – the evidence and how it informs local practice (includes discussion on abstinence vs. harm reduction, naloxone and psychosocial support groups)…..Erin Knight

10:15 – 10:30 Coffee Break (provided)

10:30 – 11:00 Now what? Includes things to consider starting out in ORT practice, who’s doing what out there and the exemption process…..Marina Reinecke

11:00 – 12:00 Pharmacology of methadone and buprenorphine/naloxone and prescriber – pharmacist collaborative care…..Nicole Nakatsu

12:00 – 12:30 Lunch (provided)

12:30 – 13:15 The comprehensive patient assessment…..Talia Weisz

13:15 – 14:15 From Initiation to the Maintenance phase – Dose adjustments, Urine toxicology, Carries, Split dosing, Management of concurrent alcohol; benzodiazepine; OTC medication use, Insomnia…..Erin Knight

14:15 – 14:30 Coffee Break (provided)

14:30 – 15:30 (Pharmacists) Break-out session # 1 – Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 1: An overview…..Mike Sloan

Prescribers Standardized patient (Talia & Nicole) interviews -2 groups (Ginette & Erin facilitates)

15:30 – 16:25 (Prescribers and Pharmacists) Break-out session # 2: Case discussions – Erin, Marina, Nicole & Mike facilitates

16:25 – 16:30 Day 1 Evaluation forms

Day 2 Agenda April 13:

8:00 – 8:30  Check In and Coffee

8:30 – 8:45  Reflections from day 1 and Lindy’s tool

8:45 – 9:30:  Withdrawal of Treatment…..Marina Reinecke

9:30 – 10:15   Special Considerations: HIV and Hep C in the context of Opioid Replacement Therapy…..Laurie Ireland

10:15 – 10:30  Coffee Break (provided)

10:30 – 11:30  Special Considerations: Pregnancy….Marina Reinecke

11:30 – 12:30   (Prescribers) ORT and co-occurring psychiatric disorders – a 45 minute primer…..James Simm

11:30 – 12:30  (Pharmacists) Break-out session # 3 – Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 1 continued: Witnessed ingestion…..Mike Sloan

12:30 – 13:00  Lunch (provided)

13:00 – 14:00  Special Considerations: Acute and chronic pain in the context of opioid replacement therapy…..Kulvir Badesha

14:00 – 15:00  (Pharmacists) Break-out session # 4: Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 2: Special situations…..Mike Sloan

Prescribers:  Standardized patient (Talia & Nicole) interviews -2 groups (Ginette & Marina facilitates)

15:00 – 15:15  Coffee Break (provided)

15:15 – 16:15  (Prescribers and Pharmacists) Break-out session # 5: Case discussions – Marina, Nicole & Mike facilitates

16:15 – 16:30  Wrap-up, Day 2 and Overall Evaluation Forms, Post-test

Prior to attending this workshop participants are required to complete the following prerequisite readings listed below:

Methadone Maintenance Treatment: Client Handbook REVISED; Can be found at:
www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/methadone/Documents/mmt_client_hndbk.pdf

The College of Physicians and Surgeons of Manitoba’s publication: “Manitoba Methadone & Buprenorphine Maintenance: Recommended Practice”. Can be found at:
http://www.cphm.ca/uploaded/web/Guidelines/CPSM%20Manitoba%20Methadone%20&%20Buprenorphine%20Maintenance%20-%20Recommended%20Practice%20.pdf

The College of Pharmacists of Manitoba guidelines: “Principles for the Provision of Opioid Dependence Treatment by Manitoba Pharmacists (required reading for pharmacists only); Can be found at:
http://www.cphm.ca/uploaded/web/Guidelines/ORT%20/Opioid%20Replacement%20Therapy%20Guidelines%20for%20Manitoba%20Pharmacists.pdf

General Inquiries or questions regarding the workshop can be directed to your Regulatory Body:

Marina Reinecke MBChB, CCFP (ISAM Certified), Medical consultant, CPSM
marinajoel@mymts.net or 204 294 2162

Diana Heywood RN MN, Practice and Standards Consultant, CRNM
dheywood@crnm.mb.ca or 204 784 6467

Kim McIntosh B.Sc (Pharm.), Assistant Registrar – Qualifications and Practice Development, CPhM
kmcintosh@cphm.ca or 204-233-1411 ext 230

Credits:

CFPC
Please be advised, in accordance with the new Mainpro+ standards, the College of Family Physicians of Canada requires that all participants are obliged to complete a post-reflective activity within 30 days of the activity in order to claim two credits per hour for the Opioid Replacement Therapy 101. This post-reflective exercise will be emailed to participants the day of the activity.

Participants will receive a certificate of participant/letter or credit hours upon completion of all components, including the post-program requirements. Participants not completing all of the required program elements will only be eligible to claim non-certified credits.

This two-credit-per-hour Group Learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by the CPD Medicine Program, University of Manitoba for up to 27.5 Mainpro+ credits.

MOC Section 1
This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada, and approved by the CPD Medicine Program, University of Manitoba for a maximum of 9.5 hours.

MOC Section 3
This activity is an Accredited Simulation Activity (Section 3) as defined by the Maintenance of Certification Program of The Royal College of Physicians & Surgeons of Canada, and approved by the CPD Medicine Program, University of Manitoba on April 4, 2018 and expires April 4, 2021. Remember to visit MAINPORT to record your learning and outcomes. You may claim a maximum of 4.25 hours (credits are automatically calculated).

Pharmacy 

The College of Pharmacists of Manitoba recognizes learning activities that have been accredited by The Royal College of Physicians and Surgeons of Canada (MOC) and/or The College of Family Physicians of Canada (Mainpro+).  Pharmacists can claim up to 13.25 (CEU) continuing medical education programs as accredited learning by selecting the appropriate accrediting body in the member’s online Professional Development Log.

Participants should only claim credit for the actual number of hours attended.

The University of Manitoba CPD Medicine Program is fully accredited by the Committee on Accreditation of Continuing Medical Education (CACME).