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

StarMetro Edmonton - - FRONT PAGE - NA­DINE YOUSIF

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

CODIE MCLACH­LAN FOR STARMETRO ED­MON­TON

"This is hit­ting Cana­di­ans hard", Dr. Ginetta Sal­valag­gio, a fam­ily physi­cian at the MacEwan Univer­sity Health Cen­tre, said of the cri­sis.

NEIL ZELLER/PRI­MARY CARE NET­WORK

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.

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