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What strategies could mitigate the
risk of abrupt cessation?
Risk reduction strategies include careful
opioid tapering, assessment and treatment for
opioid use disorder, education on overdose
risks and access to naloxone. If you have con-
cerns about a patient’s opioid use, there are
resourc es available to support you in caring
for them and reducing the risks of opioid use.
Treatment of opioid use disorders:
Physicians are not permitted to discharge
a patient from their practice because of a
suspected or diagnosed opioid use disorder.
Physicians should view opioid use disor-
der in the same way as any other chronic
health condition and treat patients with
respect and compassion. The most effective
treatment for opioid use disorder is opioid
substitution treatment with methadone or
buprenorphine/naloxone. The following
approach will help ensure that patients are
safely transferred to opioid substitution
treatment when appropriate:
1 I nform the patient that he/she likely
has an opioid use disorder, which is
causing suffering and putting him/her
at risk for death from overdose.
2 Explain that opioid substitution with
methadone or buprenorphine
will markedly improve pain,
mood and function, and while
If you have
waiting to start an opioid sub-
concerns about
stitution treatment program,
you will slowly taper the dose.
a patient’s opioid
eassure the patient that this
3 R
use, there are
will reduce the risk of overdose
resources available
and will make him/her feel
better, by lessening withdrawal
to support you
symptoms and dose-related
depression and fatigue.
4 I f the patient adamantly re-
fuses, you should inform him/
her that you are obliged to act in the
patient’s best interests.
5 Taper slowly, by no more than 10% of
the total dose per week. Taper with a
long acting opioid if possible, using
Mentorship and other practice supports
• P
roject ECHO Ontario Pain: education program on man-
aging chronic pain. • Mentoring, Education, and Clinical Tools for Addiction:
Primary Care–Hospital Integration (META:PHI)
• M
edical mentoring for addictions and pain. Ontario Col-
lege of Family Physicians. • Prescribing Drugs policy, College of Physicians and Sur-
geons of Ontario (www.cpso.on.ca)
• O
pioid manager. Toronto Rehab & University Health
Network, 2015.
• Management of alcohol use disorders, opioid prescrib-
ing, and opioid use disorders in primary care: a pocket
reference for family physicians. Women’s College Hospital,
February 12, 2016.
Issue 3, 2016 Dialogue
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