Opioid Agonist Therapy 101 Introduction to Clinical Practice October 20 and 21 2022 Winnipeg MB

*As part of our efforts to ensure the health and safety of our community, staff, students and faculty, and in alignment with University of Manitoba policy, wearing of masks is mandatory*

This workshop will arm you with new knowledge and skills around opioid addiction and
the resources available to support this vulnerable patient population; it is a prerequisite
training requirement in order to prescribe or dispense methadone and buprenorphine/
naloxone in Manitoba.

Broad Learning Objectives:

At the conclusion of this workshop, participants will:

• Have acquired the prerequisite knowledge to initiate and monitor patients on methadone and/or buprenorphine/naloxone.
• Be able to demonstrate basic decision making skills essential to providing or dispensing safe and effective opioid agonist therapy.
• Be able to explore 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 acute, chronic, and post-operative pain.
• Identify special considerations in the management of individuals with opioid use disorder and hepatitis C and/or HIV.
• Identify special considerations in the management of individuals with opioid use disorder who are indigenous and/or from indigenous communities.
• 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.
• Discuss important safety considerations and formulate a practical approach to managing individuals with benzodiazepine use and/or with complex polypharmacy.
• Distinguish different models of service delivery in opioid agonist 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 and buprenorphine/naloxone into pharmacy practice.

Day 1 Agenda October 20:

0800 Check In and Coffee

0820 Introductions and Orientation to the Workshop (Includes pre-test)

0840 A Review of Opioid use disorder and emerging inpatient and community disease patterns…..

0900 Treatment approaches – the evidence and how it informs local practice (includes discussion on abstinence vs. harm reduction, naloxone and psychosocial support groups)…..

1000 Coffee Break (provided)

1015 Now what? Includes things to consider starting out in ORT practice, who’s doing what out there and the exemption process…..

1045 Pharmacology of methadone and buprenorphine/naloxone and prescriber – pharmacist collaborative care…..

1130 The Comprehensive patient assessment

1215 Lunch (provided)

1245 From Initiation to the Maintenance phase – Dose adjustments, Urine toxicology, Carries, Split dosing, Management of concurrent alcohol; benzodiazepine; OTC medication use, Insomnia…..

1355 Benzodiazepines and opioid agonist treatment: a practical approach to care

1415 Coffee Break (provided)

1430 (Pharmacists) Break-out session # 1 – Integrating Opioid Agonist Therapy into pharmacy practice – Part 1: Examining the Current Guidelines…..

1430 Prescribers Standardized patient interviews -2 groups

15:30 (Prescribers and Pharmacists) Break-out session # 2: Case discussions

16:25 Day 1 Evaluation forms

Day 2 Agenda October 21:

0800 Check In and Coffee

0820 Reflections from day 1 and Lindy’s tool

0845 Withdrawal of Treatment…..

0925 Polypharmacy and over-the-counter medication use

0955 Special Considerations: HIV and Hep C in the context of Opioid Agonist Treatment

1025 Coffee Break (provided)

1040 Special Considerations: Pregnancy….

1130 (Prescribers) Opioid Agonist Treatment and co-occurring psychiatric disorders – a 45 minute primer

1130 (Pharmacists) Break-out session # 3 – Integrating Opioid Agonist Therapy into Pharmacy Practice- Part 2: Witnessed ingestion…..

1230 Lunch (provided)

1300 Special Considerations: Acute, chronic and perioperative pain in the context of Opioid Agonist Therapy

1330 Special Considerations: Indigenous Health and Opioid Treatment

1400 (Pharmacists) Break-out session # 4: Integrating Opioid Agonist Therapy into Pharmacy Practice – Part 3: Special situations…..

1400 Prescribers: Standardized patient interviews -2 groups

1500 Coffee Break (provided)

1515 (Prescribers and Pharmacists) Break-out session # 5: Case discussions

1615 Post-Test, Day 2  Evaluation form, 2 consent forms and wrap up

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:

https://www.camh.ca/-/media/files/guides-and-publications/making-choice-en.pdf

The College of Physicians & Surgeons of Manitoba publication, Manitoba Opioid Agonist Therapy Recommended Practice Manual. Please note, this manual is in development and provides recommendations for both buprenorphine/naloxone and methadone; published chapters are available at the OAT Recommended Practice Manual page for review while awaiting the completed manual. Please read all chapters posted on this webpage.

The College of Pharmacists of Manitoba guidelines: Opioid Agonist Therapy Guidelines for Manitoba Pharmacists (OAT Guidelines) (required reading for pharmacists only); Can be found at:

OAT Guidelines for Manitoba Pharmacists

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

Marina Reinecke MBChB, CCFP (ISAM Certified), Medical consultant, CPSM
MReinecke@cpsm.mb.ca 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

Registration:

Physicians: $1250.00
Pharmacists: $400.00
Residents: $500.00
Nurse Practitioners: $500.00
Physician Assistant: $400.00
Clinical Assistant: $400.00
Other Nursing Profession: $400.00
Other Health Professions: $350.00

As Per CPD Medicine policy, the department requires any refund or cancelation request to be submitted in writing up to fourteen (14) days prior to the program or session start date . A $50 administrative fee will be withheld to cover transaction and administrative costs.
No refunds or cancelation requests made 1 week prior to workshop.
No transfers permitted a week prior to the workshop.

Credits

This event was co-developed with the CPD Medicine Program, University of Manitoba and was planned to achieve scientific integrity, objectivity and balance.

This two-credit-per-hour Group Learning program meets the certification criteria of the College of Family Physicians of Canada and has been approved by the CPD Medicine Program, University of Manitoba for up to 28.0 Mainpro+ credits.

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 29, 2021 and expires April 29, 2024. Remember to visit MAINPORT to record your learning and outcomes. You may claim a maximum of 3.0 hours (credits are automatically calculated).

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 14.0 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).