ON THE FRONT LINE
Most family doctors have the capacity to prescribe opioids, but fewer are able to prescribe treatments. Alberta’s Primary Care Network is hoping to change that
Family doctors care for a wide range of issues, from diabetes to high blood pressure, from contraception to mental health. Their clinics are often a revolving door of patients of all ages.
But with the ongoing opioid crisis that has swept Alberta and the rest of the country, family doctors in the province seek a bigger role helping people with addictions — and the number of patients with addictions is growing.
Family physicians in Alberta want to be able to prescribe methadone — a treatment drug for opioid addictions that subdues withdrawal symptoms. But doctors need approval to do that.
“This is hitting Canadians hard,” said Dr. Ginetta Salvalaggio, a family physician at the MacEwan University Health Centre in Edmonton.
The latest data shows 562 Albertans died from an apparent fentanyl-related overdose in 2017 — up from the 358 deaths in 2016. On average, two people die every day in Alberta due to accidental opioid overdose.
Salvalaggio is part of the province’s Primary Health Care Opioid Response Initiative. Funded by a $9.5-million grant from Alberta’s Ministry of Health, it is designed for family doctors, helping them provide care for patients with an opioid addiction. It includes online courses, in-person sessions and presentations at conferences across the province, Salvalaggio said.
In its early stages, it is “unique to Alberta,” said Terri Potter, executive director of the secretariat for the opioid initiative. In addition to increasing the number of family doctors who can prescribe methadone or Suboxone, a stronger treatment drug for opioid addiction, doctors are also encouraged to take courses on the mindful prescribing of opioids, and identifying when a patient may be developing an addiction or is in need of help.
Dr. Christine Luelo, a Calgarybased family doctor, said most physicians can prescribe opioids for pain management, but a smaller number of doctors can prescribe methadone.
Luelo, who is involved with the provincial opioid initiative with a focus on Calgary, is now working toward certification to provide methadone treatments to her patients. Previously, most family doctors had to refer patients with opioid addictions to an out-of-clinic specialist.
Potter said restrictions for prescribing Suboxone were lifted in spring 2017, allowing physicians to prescribe it to patients without special certifications. But barriers still exist for family doctors to prescribe methadone, also known as Full Opioid Agonist Treatment, who require special education and certification before being able to do so.
Luelo said family physicians in Calgary have been receptive to receiving additional education with respect to the opioid crisis. “We were completely overwhelmed by the response received,” Luelo said.
But not all family physicians in the province have responded positively to these new efforts. Potter acknowledged some doctors have shown reluctance, mainly due to worries about being able to provide the same level of care as those who are specialized to treat addictions.
Others are worried about limited time or resources for a group of doctors that can often be overworked, Salvalaggio said.
“This work is so rewarding because you see people feeling better so fast,” she said. “But it’s still a matter of demystifying and destigmatizing the conversation first.”
Salvalaggio also acknowledged that not everyone has access to a family doctor, so some may be dealing with their addiction alone.
“We’re not going to be able to help everybody … But we’re going to be able to find a very large number if we just invest some time.” Read the full story at thestar.com/edmonton
“WE WERE COMPLETELY OVERWHELMED BY THE RESPONSE RECEIVED.” Dr. Christine Luelo, family doctor
"This is hitting Canadians hard", Dr. Ginetta Salvalaggio, a family physician at the MacEwan University Health Centre, said of the crisis.
Dr. Christine Luelo, a family physician based in Calgary, is working towards obtaining certification to be able to provide addiction treatments to patients who heavily use opioids.