Pain Management and Opioid Prescribing

In 2016, the ​College of Physicians and Surgeons of British Columbia (CPSBC) ​created new opioid prescribing standards (Safe Prescribing of Drugs with Potential for Misuse or Diversion) in response to BC's growing opioid crisis, meaning that BC doctors are now legally bound by mandatory professional standards for safe prescribing of opioids and other addictive drugs.

In 2017, the ​BC Centre for Substance Use released A Guideline for the Clinical Management of Opioid Use Disorder. There are also two new supplements to the guideline:

Opioid Use Disorder - Diagnosis and Management in Primary Care

Treating Opioid Use During Pregnancy

To assist physicians in complying with these guidelines and standards, and ​to help address ​substance use issues in their own communities, many divisions of family practice are hosting local learning events and ​creating and compiling resources on opioid prescribing and alternative pain management modalities​.

Some of these are clinical resources intended for a physician audience (i.e., to support decision-making in the prescribing process) and some are resources and community links that physicians can provide to patients on ​alternative pain management strategies.

To learn more about what divisions are doing to support physicians with opioid prescribing and pain management recommendations, see the links below.

 

Patient resources

Chilliwack Mini Med School presentation: Fentanyl, Addiction, and Homelessness... what can we do?

Comox Safe Opioid Practices page. Public awareness talk (on Shaw TV) on local mental health and substance use issues and resources by Dr Charuka Maheswaran.

Northern Interior Rural Pain Improvement. Chronic pain self-management resources compiled by Dr Judy Dercksen. Featured in the BC Medical Journal.

 

Physician resources

Central Okanagan RACE (Rapid Access to Consultative Expertise) project (includes chronic pain specialists). Link for members to Okanagan Interventional Pain Clinic.

Comox Valley Comox Valley Safe Opioid Prescribing Algorithm. Comox Valley Safe Opioid Prescribing Algorithm Tools and Resources.

Kootenay Boundary Chronic Pain Management toolkit. Chronic pain brochure. Chronic pain resource list​ for Nelson and Lower Columbia (Trail, Rossland, Fruitvale) focusing on: Medical Resources. Cognitive Therapy. Bodywork. Self Management. Complementary Methods. Education.

Nanaimo Opioid and ​pain ​resources for physicians (guidelines, assessment tools & information, and community resources). Clinical resources for opiate and pain management. Suboxone info sheet/handout (this resource can be repurposed by other divisions, crediting the Nanaimo division). ​Using a dedicated virtual mobile number (VMN) to set up a text hotline: A resource for divisions who may wish to set up their own e-mentor text support program for physicians.

Victoria MHSU Learning Series - Navigating Opioids, Addiction & Pain: The Patient, the Physician, & the College.

 

Provincial (non-division) resources

Medical Services Commission (MSC) Payment Schedule. Includes April 26, 2017 update to fee items related to treatment of opioid use disorder.

Doctors of BC policy paper: "Improving chronic pain management."

Practice Support Program Pain Management Module.

College of Physicians and Surgeons of British Columbia: Safe Prescribing of Drugs with Potential for Misuse/Diversion.

BC Centre for Disease Control (BCCDC): Toward the Heart and Harm Reduction​​.

BC Centre on Substance Use: Clinical Care Guidance Publications and information sheets.

Pain BC: ​Conferences, assessment tools, and articles for health care providers.

Provincial Guidelines for Biopsychosocialspiritual Withdrawal Management Services: Guidelines for Adult and Youth.

UBC's "This Changed My Practice:" Managing Opioid Withdrawal.

Printable Ministry of Health rack cards, wallet cards, and posters on how to prevent overdoses. (To receive printed copies of these materials free of charge, fill out this order form and send to margaret.case@gov.bc.ca).

Journey Mapping Substance Use Treatment: An Exploration of Health Care Provider and Peer Experiences in Delivering and Receiving Primary Care. A collaborative document created by the Ministry of Health, First Nations Health Authority, FPSC, and BC Patient Safety and Quality Council.

 

Health Authority resources

First Nations Health Authority: Substance Use Prevention and Treatment.

Fraser Health Authority: Mental Health and Substance Use.

Interior Health Authority: Mental Health and Substance Use Services.

Island Health Authority: Mental Health and Substance Use Services and Resources.

Provincial Health Services Authority (PHSA): BC Mental Health & Substance Use Services.

Northern Health Authority: Mental Health and Addictions.

Vancouver Coastal Health Authority: Substance Use Services.

 

FPSC fee codes and other supports

Doctors can access opioid agonist therapy support through FPSC fee incentives and Pharmacare coverage to address pain management and opioid prescribing. These include:

FPSC Mental Health Initiative.

MSP Fee Items for OAT: 13013 (Assessment for Induction of Opioid Agonist Treatment (OAT) for Opioid Use Disorder). NEW. 13014 (Management of OAT Induction for Opioid Use Disorder). NEW. 00039 (Management of Maintenance OAT for Opioid Use Disorder). UPDATED. 15039 (GP Point of Care (POC) testing for opioid agonist treatment​). 15040 (GP Point of Care (POC) testing for amphetamines, benzodiazepines, buprenorphine/naloxone, cocaine metabolites, methadone metabolites, opioids and oxycodone).​

Pharmacare coverage: Effective February 1, 2017, Pharmacare will cover Methado​se for maintenance and buprenorphine/naloxone under its Psychiatric Medications Plan (Plan G). More information: Coverage of Methadose and Buprenorphine/Naloxone under Plan G. Pharmacare newsletter.