News

Atlantic Mentorship Network for Pain and Addiction - Upcoming Events

 
 
THE PRESCRIBING COURSE
Safe Opioid Prescribing for Chronic Non-Cancer Pain
January 28, 2017
8:00am - 5:00pm
Westin Nova Scotia
Halifax, Nova Scotia
 

 

Innovations, Strategies & Barriers to Chronic Pain & Addiction Care
March 3, 2017
8:00am - 5:00pm
Mi’kmaw Native Friendship Centre
2158 Gottingen Street
Halifax, Nova Scotia
 

 

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November 2016 Bulletin

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Important Information for Prescribers and Pharmacists:

  • Change in scheduling for Nucynta
  • Information required on a duplicate prescription

 


Independent Review of the Prescription Monitoring Program Completed

The Board of the Nova Scotia Prescription Monitoring Program (PMP) has reviewed and accepted an independent quality review of the program.

At the request of the Minister of Health and Wellness, the Board of the PMP commissioned an independent quality review of the program. Dr. Norman Buckley, Director of the McMaster University's Michael G DeGroote National Pain Centre and co-Chair of the Canadian Centre on Substance Abuse 'First Do No Harm' strategy against prescription drug misuse led the review. Among the recommendations included in Dr. Buckley’s final report is the need for an earlier escalation of cases that require expert review in order to more quickly identify inappropriate prescribing.

 “Nova Scotia is recognized for an enviable program of prescription monitoring. Recommendations made in our report are aimed at strengthening the program’s capacity to monitor and improve opioid prescribing,” said Dr. Norman Buckley.

 “The PMP is considered the gold standard of prescription monitoring programs in the country and we welcome Dr. Buckley’s report,” said Dr. Gus Grant, Chair of the PMP Board.

The review of the PMP was requested following criminal charges relating to alleged opioid prescribing practices of Dr. Sarah Jones. The PMP Board will work with the Department of Health and Wellness and other program stakeholders toward further review and implementation of the report’s recommendations.

 “Nova Scotians expect the PMP to take the necessary action to reduce opioid misuse and abuse in the interest of public safety. We see this review as another positive step toward further enhancements that will benefit the program and residents of Nova Scotia,” said Dr. Grant. 

 The final report of the independent quality review is available online at http://nspmp.ca/library/NSPMP_Review_201610.pdf

 


The Prescribing Course - Safe Opioid Prescribing for Chronic Non-Cancer Pain

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The Prescribing Course - Safe Opioid Prescribing for Chronic Non-Cancer Pain

October 15, 2016 - 8:00am to 5:00pm, Westin Nova Scotia Hotel, Halifax

Are you a FAMILY PHYSICIAN, NURSE PRACTITIONER, DENTIST or PHARMACIST struggling with repeated requests for early opioid refills, larger amounts or higher doses? Are you increasingly concerned for your safety, or that of your staff or patients? Then this course is for you.

The Prescribing Course: Safe Opioid Prescribing for Chronic Non–Cancer Pain is a one day course covering opioid prescribing from assessment to tapering. Developed with support from the Nova Scotia Department of Health and Wellness, the course is a one-day, small group, interdisciplinary program of case based education with brief lectures highlighting major learning points.

By taking this course, you will gain crucial knowledge necessary to prescribe or dispense these medications safely. You will learn about the following key topics:

  • Pain and Opioid risk assessment
  • Conducting an opioid trial
  • Monitoring opioid use including interpretation of urine drug testing
  • Identification and management of aberrant behaviors
  • Management of opioid side effects
  • The adopted patient on opioid therapy
  • Prescribing for patients who travel
  • Maintaining boundaries
  • Quick reference guide and tools for everyday use

All attendees receive a hard copy and electronic course manual with user-friendly “how to” information designed for daily use. Each course will be limited to a minimum of 20 and maximum of 50 participants.

Education Credit
College of Family Physicians of Canada - Group Learning - 13 Mainpro+ credits
Royal College of Physicians and Surgeons of Canada – Section 2 credit
Continuing Pharmacy Education - 13 CEU

For further information please refer to the attached flyer.

For online registration please visit: http://www.bluesmartieconsulting.com or contact Gail Sloane 902-402-4784.


Opioid Treatment Disorder

Treatment for opioid use disorder may include opioid agonist therapy (also known as opioid substitution/replacement/ maintenance therapy) with methadone or buprenorphine.

 

· Buprenorphine is subject to the federal Controlled Drugs and Substances Act. 
· Buprenorphine prescriptions are monitored by the Nova Scotia Prescription Monitoring Program.
· Unlike Methadone, a Health Canada exemption is not required to prescribe Buprenorphine in Nova Scotia.

 

Buprenorphine is commonly combined with naloxone, an opioid antagonist, to reduce the potential for intravenous use or diversion. However, buprenorphine/naloxone has significant potential to cause harm or death if improperly prescribed, used or monitored.

Physicians wishing to prescribe buprenorphine/naloxone for opioid use disorder must be properly informed in its use, including but not limited to its:

 

· indications;
· contraindications;
· risks;
· dosing; and
· treatment alternatives.

 

The Centre for Addition and Mental Health (CAMH) document Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guidelines has been endorsed by the College's Methadone Maintenance Support Program Committee and is the recommended resource. In addition, formal or informal consultation with a prescriber experienced in the use of buprenorphine/naloxone is strongly recommended. 

 

For those wishing more comprehensive preparation, the College recommends: 

 

· Buprenorphine-Assisted Treatment of Opioid Dependence: An Online Course for Front-Line Clinicians


CPSNS Endorses the US Centres for Disease Control and Prevention's Guidelines for Prescribing Opioids for Chronic Pain

At its May 27th meeting, the College Council endorsed the US Centers for Disease Control and Prevention’s (CDC) Guidelines for Prescribing Opioids for Chronic Pain as best practices for physicians in Nova Scotia.

“We recognize these guidelines represent a significant departure from present practice for many physicians,” said Dr. Gus Grant, Registrar and CEO of the College of Physicians and Surgeons of Nova Scotia.

“The existing threshold dose is 200 milligrams per day of morphine. The CDC guidelines urge caution at doses of 50 milligrams and to avoid doses in excess of 90 milligrams. In essence, this represents a dramatic change, a dramatic reduction in acceptable dosages for chronic non-cancer pain,” said Dr. Grant.

Among the CDC’s 12 recommendations is the promotion of non-pharmacologic and non-opioid therapies as preferred treatments of chronic pain. If a risk-benefit analysis indicates that opioid therapy is appropriate, physicians are advised to prescribe the lowest effective dosage with ongoing reassessment of the patient. Physicians are also cautioned to avoid prescribing opioid pain medication and benzodiazepines concurrently.

“The implementation of these new guidelines into a physician’s practice will take time. The College recognizes there will be challenges particularly with tapering dosages of long standing patients. The CDC guidelines, however, are built on a firm foundation of evidence that weighs the benefits of these medications as against the risks,” said Dr. Grant.

The College previously endorsed the Canadian guideline developed by the National Pain Centre at McMaster University. This guideline, published in 2006 is now under revision and the College looks forward to reviewing the refreshed version upon its completion.


Canada Post Service Disruption

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June 2016 eAccess Bulletin

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A Conference in the Community: Pain & Addiction in Vulnerable Populations

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The Atlantic Mentorship Network - Pain & Addiction is offering 'A Conference in the Community: Pain & Addiction in Vulnerable Populations'. Co-hosted by the North-End Community Health Centre.

The one day conference will consist of:

  • Keynote Address by Dr. Doug Gruner on "Pain, Addiction, and New Refugees"
  • A number of  concurrent sessions and speakers

Topics will include:

  • Barriers and Opportunities in Providing Pain & Addiction Care in the African Nova Scotian Population
  • Pain & Addiction Treatment in the Refugee Population
  • Homelessness, Pain & Addiction
  • Elsipogtog First Nations Methadone Program & Onsite Dispensing, Harm Reduction Approach
  • Cultural Awareness
  • Community Engagement & Service Learning in Halifax
  • Homelessness, Pain & Addiction
  • Violence & Trauma Informed Practice: Decolonizing Community Care

Upcoming Course Date:

  • March 4, 2016-Mi'kmaw Native Friendship Centre

For further information please refer to the attached flyer.

For online registration please visit: www.bluesmartieconsulting.com under the Events tab. To register by mail please download the attached flyer and submit the registration from.


January 2016 Bulletin

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In this issue:

  • eAccess password resets
  • Course notification
  • Duplicate prescription pad orders
  • DIS and NSPMP monitored drug claims
  • Part fills

The Prescribing Course - Safe Opioid Prescribing for Chronic Non-Cancer Pain

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The Atlantic Mentorship Network - Pain & Addiction is offering "The Prescribing Course - Safe Opioid Prescribing for Chronic Non-Cancer Pain (CNCP). The Prescribing Course will consist of

  • A one day workshop covering all aspects of opioid prescribing through small group, interdisciplinary and case-based discussion.
  • A user-friendly "How-to" handbook (in both hard copy and electronic formats) providing quick access to detailed information on all aspects of prescribing opioids for CNCP.

Topics will include:

  • Opioid prescribing including risk assessment, opioid dosing, opioid rotation and tapering
  • Monitoring, including urine drug testing and aberrant behaviors
  • Management of side effects
  • Special topics including; the adopted patient, prescriber and pharmacist collaboration and maintaining boundaries
  • A quick reference and a number of tools designed for everyday use

Accreditation: This program meets the accreditation of the College of Family Physicians of Canada and has been approved for 6.5 MainPro-C credits, 6.5 MainPro-M1 credits, Section 2 and 13 CPE credits.

Upcoming Course Date:

  • January 23, 2016 - Atlantica Oak Island Inn Resort, Western Shore, NS (Special room rates available).

For further information please refer to the attached flyer.

For online registration please visit: http://www.bluesmartieconsulting.com/ or contact Gail Sloane, (902) 402-4784 or by email at info@bluesmartieconsulting.com.


Centre for Addiction and Mental Health Opioid Dependence Treatment (ODT) Core Course

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In conjunction with Addiction Services across Nova Scotia, the Centre for Addiction and Mental Health (www.camh.ca) will offer its opioid dependence treatment (ODT) core course in Nova Scotia. This course prepares pharmacists, physicians, nurse practitioners, nurses and clinicians to provide a comprehensive range of services for people with opioid dependence. This course is required by the College of Physicians and Surgeons of Nova Scotia to obtain an exemption to prescribe methadone for opioid dependence in Nova Scotia.

The course consists of five modules that will be available on October 22, 2015 and a one-day workshop in Halifax on November 22, 2015. Registration closes on October 21, 2015.

The course is approved for the following Mainpro CPD credits from the College of Family Physicians of Canada:

  • Up to 22.5 Mainpro-M1 credits for the Opioid Dependence Treatment - Core course.
  • Up to 6 Mainprop-C (and 0 Mainpro-M1) for the one-day workshop.

The course is also approved for up to 15.5 Section 1 credits for the online portion of the course from the Royal College of Physicians and Surgeons of Canada.

Additionally, the course is also approved by The Candian Council on Continuing Education in Pharmacy for 20.5 CEUs and The Canadian Addiction Counsellors Certification Federation for 20 CEUs.

For more information, visit or call Robyn Steidman at (416) 535-8501, extension 6640.


July 2015 Bulletin

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In this issue:

  • Reminder to call 1-844-550-1651 when you require an eAccess password reset.
  • Information about the upcoming Atlantic Pain Conference.
  • Information about DIS/NSPMP monitored drug claims.
  • Information about out of province prescriptions for benzodiazepines.
  • Important reminders.

Out of Province Prescriber Registration for Prescribing Targeted Substances - DIS Pharmacy Specific

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The attached bulletin explains the requirement for out of province prescribers to register with PMP if they prescribe targeted substances which will be dispensed in DIS pharmacies in Nova Scotia. This bulletin does not apply to pharmacies that have not transitioned to the DIS.


CPSNS Launches Prescription Medication Awareness Campaign

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The College of Physicians and Surgeons of Nova Scotia (CPSNS) is launching an awareness campaign aimed at encouraging patients and physicians to explore pain management alternatives. The goal of the campaign is to support a broader conversation between patients and physicians when dealing with pain management.

The campaign, through the use of ads, posters and billboards, together with a dedicated website righttoolforthejob, seeks to support a physician-patient conversation about effective pain management options best suited for each individual's situation.

The campaign begins September 29, 2014 and will continue through to the end of December 2014.

For more information please review the attached document or visit the CPSNS website.


New Monitored Drug Prescribing Policy for Physicians in Nova Scotia

On March 21st, the Council of the College of Physicians and Surgeons of Nova Scotia (CPSNS) approved a new policy regarding the prescribing of monitored drugs. The new policy specifically addresses a physicians responsibility to reivew NSPMP patient profile information, via the the NSPMP eAccess online web application, "when caring for patients in episodic, urgent or emergent care settings" . 

This policy becomes effective June 1st, 2014. A copy of the policy can be accessed on the CPSNS website.  

Please note that providers must first register for eAccess by completing a registration and user agreement form. Questions pertaining to eAccess can be directed to PMP at 902-496-7123 or toll free at 1-877-476-7767.


Doctors Nova Scotia Magazine Article on NSPMP eAccess Service

To read the Nova Scotia Prescription Monitoring Program's eAccess Service article in the November 2013 issue of the doctorsNS Magazine (pg 19), please click on the following link http://www.doctorsns.com/site/media/3Dissue/doctorsns-november2013/index.html

eAccess is a service which provides prescribers and pharmacists with access to NSPMP patient claims history, regardless of time of day, though a secure online web application.

For more information about eAccess click on the following link to review the eAccess User Guide http://www.nspmp.ca/library/00000256-library.pdf .

To obtain copies of the eAccess Registration and User Agreement forms click on the following http://www.nspmp.ca/library/00000224-library.pdf

You can also contact the NSPMP at 902-496-7123 or toll free at 1-877-476-7767.


Information for Out of Province Prescribers Registered with PMP

The Nova Scotia Department of Health and Wellness will begin implementing a province-wide Drug Information System (DIS) in summer 2013. The DIS is a component of Nova Scotia’s electronic health record system, which is called SHARE (Secure Health Access Record). The DIS will provide authorized Nova Scotia health care professionals with access to patients’ comprehensive medication histories to inform clinical decisions in support of safe and appropriate drug therapy.

Once a Nova Scotia pharmacy connects to the DIS, every prescription dispensed by the pharmacy will be recorded in the DIS, including prescriptions monitored by the Nova Scotia Prescription Monitoring Program (NSPMP). The NSPMP will then receive daily feeds from the DIS of all prescriptions for monitored drugs dispensed in those pharmacies connected to the DIS. While this process will be transparent to you and will not impact profiles accessed through the NSPMP eAccess website, it does mean that you will be identified as a prescriber on all your prescriptions (not just monitored prescriptions) recorded in the Nova Scotia DIS.


College of Physicians and Surgeons of NS Methadone Maintenance Treatment Handbook

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On June 6, 2012 the College of Physicians and Surgeons of NS (CPSNS) released the Methadone Maintenance Treatment Handbook.

This document has been designed to assist both the experienced MMT physician with a focused practice in addiction medicine and the family physician who takes on this role as a component of a busy comprehensive family practice to meet a local need.

The MMT Handbook is available on the CPSNS website at the following link: http://cpsns.ns.ca/DesktopModules/Bring2mind/DMX/Download.aspx?Command=Core_Download&EntryId=62&PortalId=0&TabId=180


NSPMP Statement to the Auditor General's May 30, 2012 Report

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The Office of the Auditor General of NS conducted an audit of the Nova Scotia Prescription Monitoring Program. The report was released to the public on May 30, 2012. The attached document is the NSPMP statement  to key stakeholders.


Opioid Treatment Agreements

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The Nova Scotia Prescription Monitoring Program has the ability to monitor treatment agreements on behalf of prescribers. In order to begin the monitoring process, prescribers will be required to register the treatment agreement with the Program. A sample treatment agreements isavailable for download by clicking on the attached document link or by contacting the NSPMP. Completed agreements can be faxed to 902-481-3157.

If you have any questions about opioid treatment agreement monitoring, please contact the NSPMP at 902-496-7123 or toll free at 1-877-476-7767.


Prescription Drug Overdoses in NS Working Group: Recommendations

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On January 15, 2010, Chief Mark Mander, Kentville Police Services, wrote a letter of concern to the Ministers of Health and Wellness, Justice, and Community Servcies regarding the untimely drug-related dealth of a young person in Annapolis Valley. The Minister of Health and Wellness, in response to this letter and to similar concerns expressed by both community members and those working in related areas, created the Prescription Drug Overdoses in Nova Scotia Working Group with representation from the three departments plus other key professionals.

The mandate of this working group was to develop recommendations that would begin to address the need to facilitate more timely interventions and respond more effectively to the negative impacts of prescription drug abuse, including overdose and death.


Opioid Manager point-of-care tool

The Opioid Manager is designed to be a point-of-care tool which distills onto one double-sided page, essential information and advice from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-cancer Pain.
 


New Canadian Guideline for CNCP

The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain© 2010 was recently published by the National Opioid Use Guideline Group (NOUGG) as a national, evidence-based guideline to help primary-care physicians and specialists safely and effectively use opioids to treat patients with chronic non-cancer pain (CNCP).

Complete versions of the guideline are available in English in electronic formats from the Michael G. DeGroote National Pain Centre at McMaster University.
 

 


Opioid Prescribing in Nova Scotia

Poster sessions and abstract presentations by Wright, A S, MacDougall, P, Foran, A. relating to opioid prescribing in Nova Scotia.