“This innovative approach will enable pharmacists, in consultation with physicians, to help patients better manage their chronic pain and use medication more safely, particularly helping those patients who are taking very high doses of opioids,” said Jane Alcorn, USask dean of the College of Pharmacy and Nutrition. “This new way for health professionals to work together will ensure that pain management is both effective and accessible, and will have relevance across Canada.”
Funded by Health Canada’s Substance Use and Addictions Program, USask pharmacy researchers Derek Jorgenson and Katelyn Halpape will lead a team to implement and test the new approach. Family doctors and nurse practitioners will refer patients to pharmacists who will then create individualized pain management plans that improve medication management and provide information on non-drug options. This will particularly benefit people at high risk of harm from opioids by identifying those who are good candidates for tapering down opioid doses.
More than 4,300 people died in Canada in 2018 from opioid-related, unintentional overdoses, according to the Public Health Agency of Canada (PHAC).
“Canadians are the second highest users of opioids per capita in the world, and hospital visits and deaths have been increasing dramatically,” said Jorgenson, pharmacy professor and director of the college’s Medical Assessment Centre. “Pharmacists are uniquely positioned to help address the crisis.”
The new approach will improve patient access to specialist chronic pain health professionals. Saskatchewan has only one publicly funded interprofessional chronic pain specialty clinic, which is located in Regina. Many regions across Canada have no specialized pain clinics. Queues are long in places which do have clinics.
“One in five people in Saskatchewan live with chronic pain. That’s over 250,000 people. For some, pain can have a devastating impact on their quality of life and ability to work, go to school, or participate in everyday activities,” said Susan Tupper, strategy consultant for pain quality improvement with the Saskatchewan Health Authority. “We need innovative solutions, like this exciting new program, to help people living with pain access appropriate care.”
The project funding will be used to hire two full-time pharmacists to provide chronic pain medication assessments, one part-time pain specialist physician, and one full-time pharmacist to create new patient educational materials. The lack of high-quality patient educational materials on opioid use, risks of harm, available therapies, and other related topics has been identified as a serious issue.
Pharmacists will identify patients who are good candidates for opioid agonist therapies which help treat addiction to opioid drugs such as heroin, oxycodone, fentanyl and Percocet. These therapies involve using medications such as methadone and buprenorphine-naloxone which prevent withdrawal symptoms and reduce cravings, as well as providing frequent support and follow-up care.
“For the most complex cases, a pain specialist physician will collaborate by phone with the pharmacist and the patient’s family doctor,” said Halpape, an assistant professor at USask. “By following this approach, our hope is that the majority of chronic pain patients will not need referrals to pain specialist physicians.”
The team estimates that individual patient consultations will be provided to about 480 high-risk patients per year. The program aims to reduce the risk of opioid-related harm and unintentional overdose, and has the long-term potential to reduce physician and emergency room visits, as well as hospitalizations.
The USask College of Pharmacy and Nutrition currently hosts several professional services and continuing education programs for health care providers upon which this research will build including: the Medication Assessment Centre (MAC) which helps patients across Saskatchewan manage their medications; medSask, a medication information service; and RxFiles, a program which provides comparative drug information to clinicians across the province.
The research team includes pharmacy researchers Charity Evans (associate professor and medSask director); Alex Crawley (RxFiles associate director), Eric Landry (MAC co-ordinator), and Kerry Alcorn (program evaluation and assessment co-ordinator).
If successful, the program could be expanded to other provinces, building on existing programs and clinics.