UCalgary and partners create new course for physicians to reduce opioid use

Shanali (Shan) Rahim found, as time went on, he needed higher doses of opioids to relieve the pain following surgery. “I was prescribed opioids for post-operative pain management, but controlling the pain got out of control,” says Rahim. “No matter how much I was taking, it still wasn’t enough. My family physician became concerned about prescribing the drug any longer and referred me to the Calgary Pain Program.”

Rahim’s experience is typical of many people who are prescribed opioids for pain. The dosage is small at first, but as the body adjusts, additional medication becomes necessary to manage the pain. The drug can create hypersensitivity to pain for some patients creating a “Catch-22.”

“This can be very difficult for some patients; they are in so much pain, they’re afraid to reduce the dose of opioids that they are taking,” says Dr. Lori Montgomery, MD, Alberta Health Services Calgary Pain Program medical leader and clinical associate professor at the Cumming School of Medicine. “They often aren’t aware that it may be the opioid causing some of the pain they are experiencing.”

To offer more support for patients, the University of Calgary has partnered with Alberta Health Services (AHS) and the College of Physicians and Surgeons of Alberta (CPSA) to train family doctors and specialists to safely prescribe and taper patients taking opioids. The new Wise Prescribing and De-prescribing: Opioid Skills for the Frontline Clinician course includes short podcasts, interview clips with physicians, as well as patient testimonials. The course requires attendance at two in-person workshops, three months apart, to bring physicians together to learn from each other. 

Jason Luan, Alberta’s associate minister of mental health and addiction, says creating new tools for health-care professionals is key to preventing future substance use issues in patients.

“Safe prescribing and tapering patients taking opioid medications is one of the key ways we can work to prevent future substance use issues,” says Luan. “Our government is proud to support the development of new resources and tools to make sure health-care professionals have the most up-to-date information on appropriate prescribing practices.”

“Opioids continue to be an effective treatment for acute pain management, however, family doctors need to have the skills to be able to safely manage these patients and help taper the drug when it is no longer required for pain management,” says Dr. Kelly Burak, MD, associate dean of Continuing Medical Education and Professional Development and director of AHS’s Southern Alberta Liver Transplant Clinic.

Burak faced this challenge in his own practice when a patient, who had been prescribed opioids following multiple surgeries after a liver transplant, asked for help to get off them.

“I wanted to help him, but I didn’t know how,” says Burak. “We know a lot of patients ask their family doctors for support and through this course, physicians will be able to build the skills to better understand the effects of opioids on the body, and to support their patients emotionally and physically to taper their dose.”

“The medical profession is making progress aligning opioid prescribing with the current evidence and guidelines to ensure optimal care,” says Dr. Karen Mazurek, MD, deputy registrar of the College of Physicians and Surgeons of Alberta. “This course is an important support to them in managing patients, especially those who might benefit from having their dosage tapered.”

Rahim is now on a healthy tapering plan. “I realize now, I was taking more pain medication than I should have, but I just couldn’t find the balance without help. Now, I am more active, I am using exercise to heal and getting emotional support. I think the world of my family doctor, but my doctor just didn’t have the knowledge to help me.”

Dr. Kelly Burak, MD, is the associate dean of Continuing Medical Education and Professional Development and a professor in the departments of Medicine and Oncology at the Cumming School of Medicine (CSM). He is a member of the Snyder Institute for Chronic Diseases at the CSM and director of Alberta Health Services Southern Alberta Liver Transplant Clinic.

Dr. Lori Montgomery, MD, is the AHS Calgary Pain Program medical leader and a clinical associate professor in the departments of Family Medicine and Anesthesiology, Perioperative and Pain Medicine at the CSM. She is also a member of the CSM’s O’Brien Institute for Public Health.