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College of Physicians and Surgeons of Manitoba
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At the end of this workshop, participants will be able to:
Have the prerequisite knowledge for initiating and monitoring patients on methadone and/or buprenorphine/naloxone.
Have developed basic decision making skills essential to providing or dispensing safe and effective opioid replacement therapy.
Appreciate the value of sensitivity, understanding and commitment in the delivery of addictions medicine in clinical or pharmacy practice.
Specific Learning Objectives:
By completing the assigned pre-reading and participating in this workshop, learners will, through interactive, multidisciplinary learning activities (including power point presentations with discussion, small group simulated patient interviews and case discussions and reflective exercises) achieve the following objectives:
- Review opioid use disorder (neuroanatomy and pathophysiology of the brain’s reward system, typical clinical presentations, typical behaviours, DSM-5 criteria).
- Review 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.
- Understand 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.
- Understand how to assess a patient’s appropriateness for carry doses, including frequent reassessment and as-needed adjustments to carry status.
- Understand important issues in the maintenance phase of treatment, including urine toxicology, prolonged QT, split dosing, smoking cessation support and withdrawal of treatment.
- Understand 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.
- Review neonatal opioid withdrawal and understand how treatment decisions may impact withdrawal severity and overall maternal/neonatal outcomes.
- Understand the role education and advocacy plays in promoting improved neonatal/maternal outcomes and strengthening the family unit.
- Understand special issues in the management of individuals with opioid use disorder and concurrent major psychiatric disorders.
- Understand special issues in the management of individuals with opioid use disorder and concurrent true chronic pain.
- Understand special considerations in the management of the individual with opioid use disorder and hepatitis C and/or HIV.
- Develop a practical approach to managing insomnia in the patient with opioid use disorder.
- Understand important safety considerations and develop a practical approach to managing individuals with opioid use disorder who also abuse alcohol and/or benzodiazepines.
- Understand different models of service delivery in opioid replacement therapy including the comprehensive care model, private clinic model, community clinic model and family practice model. Understand the strengths and weaknesses of each model.
- Integrate and ensure safe preparation, documentation, and dispensing of methadone in pharmacy practice.
Day 1 Agenda May 10:
8:00 – 8:30 Check In and Coffee
8:30 – 8:45 Introductions and Orientation to the Workshop (Includes pre-test)
8:45 – 09:30 A Review of Opioid use disorder and emerging inpatient and community disease patterns…..Ginette Poulin
09:30 – 10:15 Treatment approaches – the evidence and how it informs local practice (includes discussion on abstinence vs. harm reduction, naloxone and psychosocial support groups)…..Erin Knight
10:15 – 10:30 Coffee Break (provided)
10:30 – 11:00 Now what? Includes things to consider starting out in ORT practice, who’s doing what out there and the exemption process…..Marina Reinecke
11:00 – 12:00 Pharmacology of methadone and buprenorphine/naloxone and prescriber – pharmacist collaborative care…..Nicole Nakatsu
12:00 – 12:30 Lunch (provided)
12:30 – 13:15 The comprehensive patient assessment Talia Weisz
13:15 – 14:15 From Initiation to the Maintenance phase – Dose adjustments, Urine toxicology, Carries, Split dosing, Management of concurrent alcohol; benzodiazepine; OTC medication use, Insomnia…..Erin Knight
14:15 – 14:30 Coffee Break (provided)
14:30 – 15:30 (Pharmacists) Break-out session # 1 – Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 1: An overview…..Mike Sloan
Prescribers Standardized patient (Talia & Nicole) interviews -2 groups (Ginette & Erin facilitates)
15:30 – 16:25 (Prescribers and Pharmacists) Break-out session # 2: Case discussions – Erin, Marina, Nicole & Mike facilitates
16:25 – 16:30 Day 1 Evaluation forms
Day 2 Agenda May 11:
8:00 – 8:30 Check In and Coffee
8:30 – 8:45 Reflections from day 1 and Lindy’s tool
8:45 – 9:30: Withdrawal of Treatment…..Marina Reinecke
9:30 – 10:15 Special Considerations: HIV and Hep C in the context of Opioid Replacement Therapy…..Laurie Ireland
10:15 – 10:30 Coffee Break (provided)
10:30 – 11:30 Special Considerations: Pregnancy….Marina Reinecke
11:30 – 12:30 (Prescribers) Special considerations: Opioid Replacement with Comorbid Mental Illness – Benefits and Risks…..James Simm
11:30 – 12:30 (Pharmacists) Break-out session # 3 – Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 1 continued: Witnessed ingestion…..Mike Sloan
12:30 – 13:00 Lunch (provided)
13:00 – 14:00 Special Considerations: Acute and chronic pain in the context of opioid replacement therapy…..Kulvir Badesha
14:00 – 15:00 (Pharmacists) Break-out session # 4: Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 2: Special situations…..Mike Sloan
Prescribers: Standardized patient (Talia & Nicole) interviews -2 groups (Ginette & Marina facilitates)
15:00 – 15:15 Coffee Break (provided)
15:15 – 16:15 (Prescribers and Pharmacists) Break-out session # 5: Case discussions – Marina, Nicole & Mike facilitates
16:15 – 16:30 Wrap-up, Day 2 and Overall Evaluation Forms, Post-test
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:
The College of Physicians and Surgeons of Manitoba’s publication: “Manitoba Methadone & Buprenorphine Maintenance: Recommended Practice”. Can be found at:
The College of Pharmacists of Manitoba guidelines: “Principles for the Provision of Opioid Dependence Treatment by Manitoba Pharmacists (required reading for pharmacists only); Can be found at:
General Inquiries or questions regarding the workshop can be directed to your Regulatory Body:
Marina Reinecke MBChB, CCFP (ISAM Certified), Medical consultant, CPSM
email@example.com or 204 294 2162
Diana Heywood RN MN, Practice and Standards Consultant, CRNM
firstname.lastname@example.org or 204 784 6467
Kim McIntosh B.Sc (Pharm.), Assistant Registrar – Qualifications and Practice Development, CPhM
email@example.com or 204-233-1411 ext 230