Opioids

Exceptional Access Program: Forms and Information related to OxyNeo

Some pharmacists have been asking us about the Ontario Government’s Exceptional Access Program, and some of the more specific details regarding OxyNeo. Below are two important and helpful links.

http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/4000/bul4557_1.pdf

http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWE&TIT=eap&NO=014-4406-87

Information on opioid conversion for chronic non-cancer pain

Given the complexities of opioid prescribing and dispensing, close collaboration between all health care professionals involved in these activities is essential. The Ontario Pharmacists’ Association is sharing our communication and recommendations to pharmacists with the Ontario Medical Association (OMA), the Ontario College of Family Physicians (OCFP), the Ontario College of Pharmacists and the College of Physicians and Surgeons of Ontario to help foster an interprofessional approach to opioid prescribing and dispensing.

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: Opioid Conversion and Brand Availability in Canada

Providers are reminded that opioid conversion charts refer to the analgesic strength of oral opioids and not to the psychoactive effects or effectiveness in relieving withdrawal symptoms. Pharmacists should refrain from making any dose conversion recommendations in instances where opioid prescribing is primarily for addiction maintenance and not for purposes of chronic pain management and particularly where there is no guarantee that the medication is being administered in the form it was intended.

Prescribers and pharmacists are strongly advised to utilize the information provided through the conversion chart, and to collaborate, agree upon, and document any medication conversion necessary so as to identify real or potential factors that are unique to the patient and/or the alternate drug.

Addendum to the February 23 email blast regarding OxyContin substitution

As a follow-up to the OPA Bulletin of February 23, 2012 regarding OxyContin substitution, OPA would like to highlight the complexities of dose conversions when moving from one opioid to another opioid. It was mentioned in the Feb.23 bulletin that conversion charts are available, and the link to a chart from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain have been posted to the OPA website under Resources/Opioids.

The guideline is quite comprehensive and pharmacists are encouraged to take the time to review the recommendations. OPA would like to point to one such recommendation in particular (R13 of the Canadian Guideline for Safe and Effective Use of Opioids for CNCP — Part B) that best be considered when making a recommendation to switch an opioid and to suggest an appropriate dose conversion.

Switching Opioids
Because of unpredictable and incomplete cross-tolerance from one opioid to another, suggested initial doses of the new opioid are as follows:

If previous opiod dose was:	Then, SUGGESTED new opioid dose is:
• High	50% or less of previous opioid (converted to morphine equivalent)
• Moderate or low	60–75% of the previous opioid (converted to morphine equivalent)

If switching to fentanyl, see Appendix B-8.1: Oral Opioid Analgesic Conversion Table (Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain). There is no evidence to support the practice of combining different types of opioids.

We encourage members to submit their comments, thoughts, and ideas to OPA by sending an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

October 27 Webinar

Click here to listen to a recording of the October 27 webinar hosted by OPA, the Ontario College of Pharmacists, the Canadian Association of Chain Drug Stores and the Ministry of Health and Long-Term Care.

FAQ

Some further questions and answers by the Ministry on the Narcotics Safety and Awareness Act 2010 [Updated October 31, 2011]

Narcotics Strategy - List of Monitored Drugs [Updated November 9, 2011]

Consolidated List of Frequently Asked Questions (Last updated December 5, 2011)

Template letters for communicating with prescribers on the NSAA

To assist in building collaborative practices for you and your local prescribers, OPA has drafted template letters for community-based and hospital-based prescribers. Pharmacists are free to adapt these letters to suit their specific needs.

Community, long-term care and family health team pharmacists are encouraged to use this template [updated Nov 7, 2011] and need only cut and paste the text from the draft letter onto your pharmacy letterhead. Ideally, letters to physicians and dentists in your area should be personalized in order to strengthen your professional relationships with them as you provide care for your mutual patients.
Hospital pharmacists are encouraged to use this template [updated Nov 7, 2011] and need only cut and paste the text from the draft letter onto the pharmacy department letterhead. In some cases, this communication may be best set up in memo format rather than letter format to individual prescribers. The template addresses the fact that the new requirements apply only to outpatient prescriptions and to discharge orders (where dispensing will occur in the community setting).