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REP 3 - CPA's Response to the Opioids Crisis

Melissa Anderson, PT
 

Every Canadian who consumes news, in print, on TV, or via the internet has heard of the opioid crisis. The number of people it touches is staggering, and the stories of loss are heart-wrenching. And this crisis, it seems, does not discriminate - literally anyone could be impacted. It seems that British Columbia is hardest hit at present- the number of deaths has actually decreased the life expectancy in that province.
 

From an advocacy perspective, the issue of the opioids crisis is an interesting one as it has both federal and provincial/territorial implications. The federal government is interested in the public health aspect of the crisis. It has spent a lot of money on assisting those currently at greatest risk of dying from drug overdose by loosening the legislation concerning safe-injection sites and by making naloxone more readily available. It is looking at changing legislation surrounding the importation of pill presses and packages from overseas.
 

The federal government realized that it could not combat the opioid crisis on its own. It brought together provinces, territories and organizations that have a stake in the opioid crisis and created the Joint Statement of Action on the Opioid Crisis, of which CPA is a signatory. This joint statement brings together each stakeholder’s commitment to help ease the crisis and reports regularly on their progress.
 

Provincial and territorial governments also have a huge role to play in a crisis like this, as they are responsible for delivering health care in their jurisdiction. It is these governments that make decisions about the delivery of mental and physical health care that could help impact the crisis at a local level. The decisions to add greater access to addiction services, mental health counselling, or pain management services is made at this level.
 

It is at this local level where the provincial and territorial branches of CPA are positioned to advocate for change. The branch volunteers and staff are knowledgeable about the needs of the population and the resources required to help. The branches are able to mobilize their members and encourage grass-roots lobbying efforts. It is here where changes to health care delivery are made.
 

The structure of CPA was designed to take advantage of the federal/provincial/territorial divide in government. Nationally, we can advocate to the federal government on issues that are relevant to the health of Canadians. Locally, the branches can advocate to the provincial and territorial governments on issues related to the delivery of health care. Success in one jurisdiction can spread to other jurisdictions when everyone works collaboratively.
 

CPA acknowledges that the opioid crisis is far bigger than any one profession, and that it will take a multi-pronged approach to solve this health crisis. One area where we believe that we can make an impact is in the upstream treatment of pain. If physiotherapy and other conservative pain management strategies can be optimized, there may be fewer initial prescriptions for opioids necessary.
 

To date, these are the initiatives that CPA has been involved with:  

 

What else can Canadian physiotherapists do to help provide upstream solution to the opioid crisis?

What knowledge or skills do you need to be able to respond to the needs of the patients that you are seeing?

 

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Comments

Thanks Melissa for the great summary! It is great to hear about CPA's advocacy efforts. I would like to highlight your point that top-down and bottom-up approaches are needed. The bottom-up, improved pain management, approach is what will likely resonnate with most readers. It is important to continue to have conversations about what the 'opioid crisis' means for the people we work with. What are the situations where opioids are appropriate? What is the role of PTs in helping people living with pain understanding the risks and benefits of opioids for pain management? Am I familiar with the Opioid Guidelines (http://nationalpaincentre.mcmaster.ca/guidelines.html)? What is the impact of mental health on pain and how comfortable am I in indentifying mental health challenges and helping people find resources? How confident am I in managing high-impact pain? Asking these questions will hopefully stimulate seeking answers and better care for people living with pain. The self-assessment of pain pain knowledge that Melissa referred to can be found here: https://painscience.ca/pdtool/. 

Appreciate the comments- and agree that there is much more work to be done. I have included another link to the self assessment toolkit for those who are not members of the Pain Science Division (but you should consider joining!). 

https://physiotherapy.ca/sites/default/files/self_assessment_legalsized_digital2.pdf?pdf=selfassessmenttool  

@CPA_Melissa

Thank you for this valuable and important information. 

Do you happen to have something along the lines of a handout for the patient, to be able to educate them re. “This is a list of commonly prescribed medications - you may not know it, but you are taking opioids”?

Thank you,

Katerina  

 

 

 

 

Thanks for your comment, Katerina. CPA does not currently have a handout like this- but would suggest that you reach out to the Canadian Pharmacists Association (https://www.pharmacists.ca) or a group like the Canadian Deprescribing Network (https://www.deprescribingnetwork.ca) who are better able to advise on medications. 

@CPA_Melissa

Thanks for the great overview. Medications is still something I know very little about, and will be looking in to the above comment about getting a list of common medications to look for.

I think one of the biggest struggles for me initially as a PT was my lack of confidence in being able to deliver education on pain. I feel that pain sciences is one of the areas not covered in enough depth during our Masters degree. And living and working in a rural area creates challenges on accessing pain sciences courses (or courses in general). Luckily I am a member of the pain sciences division, and have completed their mentorship program with Clinical Specialist Mike Sangster. I have also had the opportunity to complete two courses with Mike Sangster. I really believe you need to have a good grasp on being able to deliver pain education, and appropriate outcome measures to use during your objective assessment in order to be able to successfully make in impact in the upstream treatment of pain. 

 

Thanks for your comments. Pain is such a complex topic. When I started looking into the opioid crisis two years ago, I had no idea how much pain science had evolved since I began my career. The leadership of the Pain Science Division has provided me with so many great resources to help expand my knowledge in this area.

As you mention, pain courses are sometimes difficult to access in rural or remote locations. There is a resource that can help. Geoff Bostic and Debbie Patterson have created an online course entitled "Pain Education: Therory & Practice" which is available on CPA's PD Marketplace, and available to all (members and non-members). You can access the PD Marketplace through the CPA website under practice resources.

CPA is also involved with the Pain Education in Physiotherapy (PEP) iniative which is looking at the pain curriculum in Canadian physiotherapy programs. Some of their earlier findings have been published in Physiotherapy Canada. 
 

@CPA_Melissa

When the curriculum offered to physiotherapy students includes a robust approach to pain education unfettered by the partisan, self centered politics of this profession, then it might be in a place to competently deal with people in pain.  When the curriculum includes training in mental health and addictions that is taught by *experts*, not physios teaching physios, then progress will be a step further.  When physiotherapy embraces psychology and sociology as perspectives that are often more important to health than a suspected sacroiliac joint's alleged mobility, then again, a bit of progress will have been made.  When physiotherapy *leaders* start leading, for example, by engaging in a national, public conversation about reformation of the training programs of all allied health professions, then progress will have a chance.  Until then, physio remains deeply insulated and alone in a self-constructed silo.

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