Wednesday, November 8th, 2017

Transcription

1 ADDICTION MEDICINE SESSIONS FMF 2017 Session Number: Name: Date: Time: Description: W173 The Opioid Epidemic: How emergency physicians can help Wednesday, November 8th, :00 12:15 Canada is in the midst of an epidemic of opioid use, dependence, and resulting harms, including an increasing rate of deaths due to overdose. Emergency physicians regularly treat patients with opioid-related toxicity, withdrawal, or related medical/psychiatric complications. They also treat patients with acute pain who may benefit from receiving prescribed opioids on discharge. Emergency physicians, therefore, are in a good position to mitigate some of the harms of the opioid epidemic and help prevent its continuation. This talk will review key interventions that can be provided in the emergency department to meet these goals. The initiation of buprenorphine/naloxone can control symptoms of opioid withdrawal, decrease other opioid use, and facilitate entrance to longer-term addiction treatment. Dispensing of injectable naloxone kits for home use can prevent overdose-related deaths. Conscientious management of acute pain and judicious prescription of opioids on discharge can help limit the misuse and diversion of these drugs. Participants will receive practical education on implementing these interventions. Evidence to support their use will be included and barriers to uptake will be explored.

2 W250 Screening for Adverse Childhood Experiences to Build Resiliency and Improve Mental Health Outcomes Wednesday, November 8th, :30 17:15 A large landmark study done by the Centers for Disease Control and Prevention and the HMO Kaiser Permanente confirmed that adverse childhood experiences (ACEs), such as exposure to violence, neglect, and abuse, are strongly associated with long-term poor mental health. In addition, the study revealed that these adverse events are associated with many other deleterious effects on health, such as increased rates of addiction, increased cardiovascular events, increased cancer rates, and earlier death. Screening for ACEs is an opportunity for family physicians to be better aware of a patient s risk factors for compromised health and an opportunity to intervene. At the end of this workshop participants will be able to use ACE screening and integrate it into everyday practice. Participants will learn how to use the insight of traumainformed care to improve the health and well-being of patients. Participants will learn to use the power of empathy, compassion, and self-care to build resiliency in both patients and themselves. Experiences of current ACE screening pilot projects will be shared with the goal of developing a variety of ways to incorporate this tool into everyday family practice and measure outcomes of ACE screening. T361 Medication-assisted Treatment for Alcohol and Opioid Use Disorders: Lessons from METAPHI Thursday, November 9th, :00 11:00 Medication-assisted management of alcohol and opioid use disorders has been shown to be safe and effective when used by family physicians in primary care settings, including anti-craving medications for alcohol use disorders (e.g., naltrexone, acamprosate) and buprenorphine for opioid use disorders. These Interventions provide better long-term care than current

3 treatment modalities, i.e., stand-alone psychosocial programs and methadone clinics. The family medicine setting offers several advantages over current treatments: It combines medication-assisted treatment with counselling; integrates addiction treatment with management of comorbid psychiatric and medical conditions; and offers flexible, easily accessible, and nonstigmatizing long-term care. Despite this, family doctors have traditionally been left out of the addiction care pathway. This creates an addiction treatment system that is overburdened, unsustainable, and ineffective. This session is intended to introduce family physicians to medication-assisted treatment. The session will consist of a didactic presentation and two short videos of office encounters with addicted patients. Increasing patient access to medication-assisted treatments was a primary objective of Project META:PHI (Mentoring, Education, and Clinical Tools for Addiction: Primary Care Hospital Integration), a two-year program designed to create an integrated care pathway between the emergency department, hospital, community agencies, and primary care. META:PHI established rapid-access addiction medicine (RAAM) clinics in or near seven hospitals across Ontario, Canada. RAAM clinics provide immediate treatment access for patients in primary care and acute care settings, shared care with family physicians, and mentorship and training to health care providers. To date, 186 primary care physicians have participated in the care pathway across seven regions. The first 152 patients who attended the RAAM clinics experienced marked

4 reductions in emergency department visits and hospitalizations. T517 Office-Based Use of Buprenorphine-Naloxone for Opioid Use Disorders Thursday, November 9, :15 12:15 Methadone has been used successfully for treating opioid use disorder since the 1960s, and remains the standard of care. While effective, methadone has several risks that require careful prescribing and dispensing practices that can be prohibitive for some patients. More recently, the combined medication buprenorphine/naloxone was approved for use in Canada, and has several advantages over methadone. In particular, it carries a much lower risk of overdose and adverse drug reactions, and is prescribed more liberally in other countries such as the United States. During this session, we will review the unique pharmacological and pharmacodynamic properties of buprenorphine-naloxone. Participants will be introduced to an office-based protocol for safe induction of buprenorphine-naloxone to prevent precipitated withdrawal. Furthermore, we will review the present provincial guidelines for the availability and use of buprenorphine-naloxone, and discuss how potential changes to these policies could result in safer, more effective treatment of opioid use disorder in a primary care setting. T248 Weeding Through the Evidence for Medical Marijuana 2.0 Thursday, November 9th, :15 17:15 This workshop continues from last year s well-attended Weeding Through the Evidence for Medical Marijuana. During this case-based presentation, participants will continue to use the CFPC s Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary Guidance document to guide clinical decision making for authorizing cannabis

5 use in chronic pain, particularly neuropathic pain. With the emergence of edible marijuana products, this workshop will also address the evidence and risks associated with these products. Specific attention will be paid to children, youth, pregnant and breastfeeding women, and individuals with comorbid mental health issues. Specific issues such as the identification and management of cannabis use disorder and driving will be addressed. Addressing challenges presented from requests for prescription cannabis will be discussed. Evidence from the preliminary guidance document as well as recent updates in the literature will be presented. F293 Addiction Medicine Networking Breakfast Friday, November 10th, :00 8:00 F70 Expanding the Primary Care Toolbox: Buprenorphine for opiate use disorder Friday, November 10th, :00 12:15 Opiate addiction is present in everyone s practice. It can be difficult to recognize in your patients and to address and treat in a compassionate but clear manner. Using both real-world cases and didactic methods, you will learn how to recognize opiate use disorder in your practice, use and interpret urine drug screens, and use buprenorphine as part of your comprehensive treatment plan for this disorder. Addiction is a chronic disease, and for many patients their disease can be monitored and followed in the family practice office similar to non-complicated cases of diabetes and COPD. S61 Smoking Cessation; Tools to make a difference in your practice Saturday, November 11th, :30 11:00 Lung cancer casuses more deaths than any other cancer in Canada, which is a scary thought. Patients know they should quit smoking, but this is an addiction; it is the most

6 Abandon du tabac : Outils pour faire une différence dans votre pratique common addictive disorder in North America. We will review how to approach this condition in the office and learn tools to allow real health change in your patients who smoke, without getting you frustrated. The International Primary Care Respiratory Group has published a position paper on smoking and we will review smoking cessation in particular patient populations to help you personalize your advice to your patients. Le tabagisme est la cause principale de décès chez nos patients, ce qui est préoccupant. Les patients savent qu ils devraient arrêter de fumer, mais nous avons affaire à une toxicomanie ; le trouble de toxicomanie le plus répandu en Amérique du Nord. Nous allons examiner la façon d aborder cette affection courante et frustrante en cabinet, et présenter des outils qui permettent d apporter des changements réels à la santé des fumeurs, sans que vous vous arrachiez les cheveux! L International Primary Care Respiratory Group a publié un énoncé de position sur le tabagisme et nous allons nous pencher sur l abandon du tabac au sein de populations particulières pour vous aider à personnaliser les conseils que vous allez donner à vos patients.