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College of Physicians and Surgeons of Manitoba
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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
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.
Day 1 Agenda December 5:
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…..
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)…..
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…..
11:00 – 12:00 Pharmacology of methadone and buprenorphine/naloxone and prescriber – pharmacist collaborative care…..
12:00 – 12:30 Lunch (provided)
12:30 – 13:15 The comprehensive patient assessment
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…..
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…..
Prescribers Standardized patient interviews -2 groups
15:30 – 16:25 (Prescribers and Pharmacists) Break-out session # 2: Case discussions
16:25 – 16:30 Day 1 Evaluation forms
Day 2 Agenda December 6:
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…..
9:30 – 10:15 Special Considerations: HIV and Hep C in the context of Opioid Replacement Therapy…..
10:15 – 10:30 Coffee Break (provided)
10:30 – 11:30 Special Considerations: Pregnancy….
11:30 – 12:30 (Prescribers) Special considerations: Opioid Replacement with Comorbid Mental Illness – Benefits and Risks…..
11:30 – 12:30 (Pharmacists) Break-out session # 3 – Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 1 continued: Witnessed ingestion…..
12:30 – 13:00 Lunch (provided)
13:00 – 14:00 Special Considerations: Acute and chronic pain in the context of opioid replacement therapy
14:00 – 15:00 (Pharmacists) Break-out session # 4: Integrating methadone and buprenorphine/naloxone into pharmacy practice – Part 2: Special situations…..
Prescribers: Standardized patient (Talia & Nicole) interviews -2 groups
15:00 – 15:15 Coffee Break (provided)
15:15 – 16:15 (Prescribers and Pharmacists) Break-out session # 5: Case discussions
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
MReinecke@cpsm.mb.ca 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