Virtual Connection – Opioid Agonist Therapy 101 Introduction to Clinical Practice April 23 and 24 2020

WORKSHOP WILL BE DELIVERED VIA VIRTUAL CONNECTION
Each participant will be virtually connected and will be able to actively ask questions and participate in the training session.

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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 replacement therapy.
• Be able to explore the value of sensitivity, understanding and commitment in the delivery of addictions medicine in clinical or pharmacy practice

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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 chronic pain.
• Identify special considerations in the management of the individual with opioid use disorder and hepatitis C and/or HIV.
• 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 and/or benzodiazepines.
• Distinguish different models of service delivery in opioid replacement 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 in pharmacy practice.

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Day 1 Agenda April 23:

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 April 24:

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

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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 and Surgeons of Manitoba’s publication: “Manitoba Methadone & Buprenorphine Maintenance: Recommended Practice”. Can be found at:

Recommended Practice Book

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:

https://cphm.ca/uploaded/web/Guidelines/ORT%20/Opioid%20Agonist%20Therapy%20Guidelines%20for%20Manitoba%20Pharmacists.pdf

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

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Registration

Physicians: $1250.00
Pharmacists: $300.00
Residents: $400.00
Nurse Practitioners: $400.00
Other Nurse Professionals: $350.00

A full refund less a $35 administrative fee will be given if cancelled 14 days or more before each event date. No refund will be given past this date.

Credits:
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.

Please be advised, in accordance with the new Mainpro+ standards, the College of Family Physicians of Canada requires that all participants are obliged to complete a post-reflective activity within 30 days of the activity in order to claim two credits per hour for the Skills Workshop. This post-reflective exercise will be emailed to participants the day of the activity.

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).