The opioid crisis has proven to be a major public health concern with the continued rise in opioid-related deaths and its significant economic impact on the health system. To help combat the opioid crisis, there is a need to develop and implement additional strategies to decrease the risk of opioid-related harms such as overdoses or the progression to opioid use disorder. Community pharmacists are well positioned to play a greater role by providing effective opioid stewardship to reduce potential opioid misuse, abuse and harm. This includes supporting appropriate prescribing and dispensing of opioids and providing patient education to promote their safe and effective use.
The Ontario Pharmacists Association (OPA), through funding from the Ontario Health Mental Health and Addictions Centre for Excellence, has developed an opioid and pain management intervention which will be implemented as a research study in community pharmacies. This research study has received ethics clearance from the University of Waterloo Research Ethics Board (REB# 45514).
Through the development, implementation, and evaluation of the OPMPP, OPA hopes to showcase the need and value of a standardized, publicly funded pharmacy-based opioid and pain management program for Ontarians.
If you have questions about the OPMPP research study, please contact the research team via email at [email protected].
OPMPP Program Resources
The following is a list of OPMPP specific resources provided to support pharmacists participating in the OPMPP research study. Pharmacists are encouraged to consult these and/or other resources as required.
Study Information for Pharmacists
- Pharmacy Manager Information Letter This is an information letter intended for pharmacy managers and/or designated owners whose pharmacy(ies) are enrolled in the OPMPP research study.
- Staff Pharmacist Information Letter This is an information letter intended for staff pharmacists enrolled in the OPMPP research study.
- Invoice Form Template This is a blank invoice form that can be used to submit an invoice to the research team to receive payment for eligible OPMPP professional service fees. Note that associated outcome measure surveys (see link below) must be completed to be eligible for OPMPP consultation professional service fees. Completed invoice forms can be e-mailed to the research team at [email protected].
- Invoice Form Sample This is a sample invoice form that has already been filled out as a guide. In the sample the pharmacy recruited 4 patients as noted by the participant ID’s and they recorded both the initial consults and any follow-ups that were conducted. Note that there is no HST to be added for the professional service fees.
- OPMPP Study FAQs for Pharmacists This is a list of frequently asked questions by pharmacists participating in the study.
- Summary of Key Steps This is a one-page summary of the study steps intended to guide pharmacists enrolled in the OPMPP research study.
Patient Recruitment Materials
- Bag Stuffer (Colour) A bag stuffer that can be provided with prescriptions at pick up, or made available at the dispensary counter, to help recruit potential patients for the OPMPP research study.
- Bag Stuffer (Black and White) A printer friendly version of the same bag stuffer described above.
- Poster A promotional poster that could be used in your pharmacy to inform patients that you are offering the OPMPP professional service as part of a research study.
- Poster (Black and White) A printer friendly version of the same poster described above.
- Verbal Consent Script A script to be used by pharmacists when speaking with potential patients about the OPMPP study that explains the program and the details of their involvement prior to obtaining verbal consent from patients who wish to participate.
- Patient Information Letter A letter provided by pharmacists to interested patients to provide them with more information about their potential involvement in the OPMPP research study prior to providing verbal consent.
- Participant ID Generator List A template to record the unique participant ID assigned to each patient participating in the OPMPP research study through the specific pharmacy. This file should be password protected and only accessible to the pharmacists at the pharmacy location participating in the study.
- Verbal Consent Log A template to document verbal consent received from each patient who has been assigned a participant ID. The pharmacy should keep one file that is accessible to all pharmacists participating in the study. This file will be shared with the research team at the end of the study period; thus patients should be noted by their participant ID only.
- Eligibility Questionnaire A screening questionnaire to be completed by patients who are interested in participating in the OPMPP study either individually or with the pharmacist after providing verbal consent to determine if they meet the study’s eligibility criteria.
- OPMPP Study FAQs for Patients This is a list of frequently asked questions by patients being recruited to participate in the study. The questions were gathered by the research team through discussion with participating pharmacists on their experiences and is intended to complement the existing patient recruitment materials.
OPMPP Consultation Worksheets
Note: these worksheets are designed to assist pharmacists with completing OPMPP consultations but will not be shared with the research team. It is not mandatory to use the OPMPP worksheets, pharmacists who wish to use another tool or system to document OPMPP consultations should note what information will be required to report in the outcome measures survey to ensure the survey can be completed accurately.
- Initial Consult Worksheet A tool to help guide and document the OPMPP initial consultation with patients.
- Follow-up Worksheet A tool to help guide and document the OPMPP follow-up consultation. Note: pharmacists should use professional judgement when deciding if and/or when a follow-up is necessary. Up to two follow-ups per enrolled patient will be eligible for a professional service fee as part of the study.
- Primary Care Provider Notification Form A notification template that can be used to communicate with the patient’s primary care provider following an OPMPP consultation. For example, to request a new prescription or to communicate a change in a medication regimen.
Research Outcome Measure Surveys
- Patient Satisfaction Survey A 5-minute satisfaction survey to be completed by patients after each OPMPP consultation (i.e., after the initial consult and each follow-up as applicable).
- Patient Satisfaction Survey – QR Code. A QR code version of the patient satisfaction survey for pharmacies to print and have accessible for patients to complete the online version of the survey.
- Patient Satisfaction Survey (Paper Copy) A paper version of the above patient satisfaction survey that can be printed and provided to the patient along with a pre-paid envelope addressed to the OPA research team if they prefer to complete a paper copy. The patient must mail this survey themselves using the pre-paid envelope. Pharmacies should invoice the OPA for the pre-paid envelope using the invoice form above.
- Outcome Measures Survey A 5-minute survey to be completed by the pharmacist after each OPMPP consultation (i.e., after the initial consult and each follow-up as applicable). Pharmacists should refer to their consultation notes to complete this survey and must provide the unique participant ID for the patient who received the consultation. Patient identifying information should not be shared. Completion of this survey is required for the applicable professional service fee to be eligible for payment. Upon receipt of the invoice form at the end of the study period (September 2024), the research team will review the submitted outcome measures surveys as proof that the OPMPP services were provided.
Note: at the end of the study period (September 2024), the research team will e-mail a survey link to all participating pharmacists to invite them to complete the Pharmacist Satisfaction Survey.
OPMPP Webinar Recording
The research team hosted a webinar on Tuesday March 5, 2024, to provide an overview of the study along with step-by-step explanations on how to complete the OPMPP consultations. This webinar also included a clinical case walkthrough and an opportunity to ask questions.
Additional Resources
The following is a list of additional resources that may be useful for pharmacists participating in the OPMPP research study. These resources are not mandatory to read or use to participate in the research study and are provided for informational purposes only.
General Resources
- Opioid Use and Opioid Use Disorder Education Resources Eight free online modules that cover several topics including but not limited to: epidemiology of opioid use; trusting, compassionate, therapeutic relationships; trauma, violence and cultural safety; opioid use education; pain management; and harm reduction.
- Toronto Academic Pain Medicine Institute (TAPMI): Resources TAPMI has resources for patients and healthcare providers including education modules, FAQs and links to opioid prescribing and tapering resources.
Chronic Non-cancer Pain (CNCP)
- Centre for Effective Practice: Chronic Non-Cancer Pain A tool designed to help healthcare professionals with developing and implementing a management plan for adults with CNCP.
- Michael G. DeGroote National Pain Centre: Guidelines A collection of guidelines including the Canadian Guideline for Opioids for Chronic Non-Cancer Pain.
- The College of Family Physicians of Canada (CFPC): Chronic non-cancer pain management and opioid resources A list of resources about CNCP and opioid management.
- Canada’s Drug and Health Technology Agency: Evidence on Pain Management A list of resources including rapid evidence reviews (Rapid Response Reports), Environmental Scans, Horizon Scans, and Optimal Use projects related to pain management.
- ECHO Chronic Pain & Opioid Stewardship Canada An interactive online medical education program that connects healthcare providers with an interprofessional specialist team to advance learning and enhance clinical skills.
- Patient Pain Diary A daily patient pain diary that can be recommended for use during patient consultations.
Opioid Stewardship
- Institute for Safe Medication Practices (ISMP) Canada: Opioid Stewardship Resources for patients and healthcare providers to become better informed about opioids and to help reduce and prevent harm.
- Centre for Effective Practice: Opioid Manager A clinical tool developed to support the management of opioid prescriptions for patients with CNCP.
- Ontario Pharmacists Association (OPA): Opioid Switching Form A form to assist pharmacists with switching opioids. Note: member login required.
- Centre for Effective Practice: Opioid Tapering Template An opioid tapering template that can be used to evaluate opioid therapies and reduce opioid dosages in safe and effective ways.
- OPA: Opioid Tapering Worksheet A tool to help pharmacists with opioid tapering.
- Canadian Pharmacists Association: Opioid Stewardship A list of webinars and tools discussing opioid stewardship for pharmacists.
Naloxone
- Canadian National Consensus Guidelines for Naloxone Prescribing by Pharmacists Practice guidelines for pharmacists that provides recommendations for naloxone prescribing, including that naloxone should be offered to everyone with an opioid prescription, in addition to practice implementation tips.
- OPA Webinar: Canadian National Consensus Guidelines for Naloxone Prescribing by Pharmacists A webinar involving a discussion of the guidelines by Professor Michael Beazely from the University of Waterloo.
- OPA: Pharmacist Clinical Tool for Initiating Naloxone Discussions A tool to assist pharmacists with initiating naloxone discussions with patients.
- University of Waterloo School of Pharmacy: Naloxone and Opioid Resources A collection of tools and resources such as infographics about normalizing naloxone distribution, naloxone counselling checklists, posters, and frequently asked questions about naloxone.
- University of Waterloo School of Pharmacy: Optimizing Naloxone Dispensing in Pharmacies A free online education program to improve knowledge and confidence in proactively offering naloxone in community pharmacies.
- OPA: Naloxone A webpage with additional resources about naloxone, including a naloxone kit supplies list, FAQs about naloxone kits, and marketing materials for pharmacies.
Stigma
- Addressing Stigma: Towards a More Inclusive Health System The Chief Public Health Officer’s Report on the State of Public Health in Canada 2019 which raises awareness that stigma is a public health issue that needs to be addressed by healthcare professionals by creating an inclusive approach to care.
- Centre for Addiction and Mental Health (CAMH): Understanding Stigma A free online course for healthcare providers to examine stigmatizing attitudes and behaviours and identify strategies to decrease stigma in healthcare environments.
- CAMH: Addressing Stigma A webpage describing the effects of stigma and seven things that can be done to reduce stigma.
Motivational Interviewing and Shared-Decision Making
- Tapering Opioids Using Motivational Interviewing This article provides example discussions with patients using motivational interviewing techniques that can be helpful when tapering opioids.
- CFPC: Simplifying Non-Pharmacological Treatments for Chronic Pain: Motivational Interviewing A tool describing the steps for incorporating motivational interviewing into practice.
- Health Quality Ontario: Opioid Prescribing for Chronic Pain – Shared Decision Making and Information on the Potential Benefits and Harms of Opioids for Chronic Pain A quality statement that highlights the importance of shared decision-making when prescribing and dispensing opioids for chronic pain.
- Agency for Healthcare Research and Quality: The SHARE Approach: A Model for Shared Decision Making – Fact Sheet A webpage that describes the SHARE Approach: a five-step process for shared decision making.
- The Ottawa Hospital: Patient Decision Aids A list of patient decision aids developed by the Ottawa Hospital that can be used to incorporate shared decision making in consultations. Notable aids include Depression, Herniated Disk, Osteoarthritis, Post-Traumatic Stress Disorder, and Sleep Disorders.
Disclaimer
These resources were compiled by the Ontario Pharmacists Association (OPA) and is provided to pharmacy professionals for informational purposes only. OPA is not affiliated with and does not endorse the organizations or resources presented and the information provided may not be comprehensive. It is intended to assist pharmacy professionals but does not replace professional judgment and responsibilities. Some information in the above references may not be up to date but are provided for reference purposes. It is provided without warranty of any kind by OPA and OPA assumes no responsibility for any errors, omissions or inaccuracies therein. The decision for use and application of this information is the responsibility of the user. OPA assumes no liability for such use and application or any resulting outcomes. It is the responsibility of the pharmacy professional to use professional judgment in evaluating this material in light of any relevant clinical or situational data. It is intended to supplement materials provided by regulatory authorities, and should there be any discrepancies, municipal, provincial, and federal laws, policies and guidelines shall prevail. Pharmacy professionals are encouraged to use other resources that are appropriate and available to them.
