Every day, five people in Ontario die from an opioid-related overdose. More than one-third of deaths involve an opioid prescribed by a physician, often a family physician. Many of these deaths also involve other medications, particularly benzodiazepines.
For years, physicians were told by pharmaceutical companies that prescribing opioids for chronic non-cancer pain was safe. We now know that is not true. However, many patients have become dependent on the medications; stopping medications suddenly can be dangerous.
A proactive, pharmacists-led approach to reducing high-risk opioid prescribing in primary care.
Our project is focused on a solution to support patients who are at high-risk of overdose because of the combination of medications they are being prescribed.
In 2018, the St. Michael’s Hospital Academic Family Health Team launched an intervention to decrease opioid-benzodiazepine co-prescribing. The intervention has three unique features. First, it’s proactive, identifying at-risk patients through a search of the electronic medical record. Second, it’s population-based, assessing risk among all 45,000 patients of the Family Health Team. Finally, it’s led by pharmacists, those who know the most about opioid medications. Pharmacists work together with doctors and their patients to come up with a plan to support patients at high risk of overdose.
The intervention is slowly being rolled out to all six of the Family Health Teams clinics. Through the rollout, we will be assessing the impact of the initiative using both quantitative and qualitative methods. For example, will track the proportion of patients who are co-prescribed an opioid and benzodiazepine. The qualitative research will examine how, for whom, in what circumstances and why the intervention worked or did not work.
Our goal is to inform solutions for safer opioid prescribing at St. Michael’s Hospital, and to help spread effective interventions to other primary-care settings.