Pubdate: Tue, 27 Jun 2017
Source: Intelligencer, The (CN ON)
Copyright: 2017, The Belleville Intelligencer
Author: Luke Hendry
Page: A2


Local LHIN, and Kingston health unit join forces

A new strategy intended to reduce opioid drug-related harm in
southeastern Ontario could be approved as early as August.

It's a partnership between the South East Local Health Integration
Network (LHIN) and Kingston, Frontenac, Lennox and Addington Public
Health. Directors of the LHIN approved the document in principle
Monday, with revisions expected this summer.

That area's new medical officer of health, Dr. Kieran Moore, led the
health unit's research. He was unavailable Monday for comment.

The project included consultation with health care providers across
southeastern Ontario.

Within that region, Hastings County in 2015 had the highest population
rate of opioid users in 2015: 2,343 per 10,000 people with public drug
plan benefits.

One fiscal year earlier, the LHIN had Ontario's highest number of
people prescribed morphine: 211 per population of 10,000 - nearly
three times the provincial rate of 73.

The strategy's intended to provide an overview of the opioid crisis in
the region and outline a response, LHIN chief executive officer Paul
Huras wrote in a report to the board.

"It became clear that there is an appropriate role for opioids in the
treatment of patients with chronic pain," he wrote, "however their use
should not be as widespread, nor should they be the first approach to
treatment in most cases."

During Monday's board meeting in Belleville, Huras asked directors to
consider the document to be "rough draft.

"It's still where we want to go," he said.

Dr. David Zelt, a Kingston doctor who's now the LHIN's new
vice-president of clinical, said doctors need more information about
their prescribing habits if they're to change them.

"This issue boils down to one challenge and that is changing physician
culture," said Zelt, who took part in Monday's meeting via

"It really boils down to what's being ordered by a lot of physicians,"
he said.

Zelt said the partners must study prescribing trends and provide the
data to doctors.

"A lot of physicians respond to information that personalizes their
particular practices," Zelt said.

Huras said all LHINs are mandated to address opioids and chronic

But he said doctors, too, are seeking solutions and the strategy will
help to identify trends in their prescribing which may be difficult
for individual physicians to spot.

"Doctors are not handing this out indiscriminately," he said of

"They want data. They want to be clinically correct."

Huras said the strategy "is not going to solve all the problems, but
it will help them and help their patients."

There are four main approaches in the strategy: reducing unnecessary
prescriptions by educating doctors; using other treatments when
possible while tapering existing opioid prescriptions; monitoring
opioid-related harm to understand the drugs' full impact; providing
harm reduction strategies for people who are unwilling or unable to
stop taking opioids.

The four points are based upon an approach used in

"There will still be some people who demand this and somehow that's
going to have to be dealt with also," Huras said.

Belleville director Brian Smith said paramedics, police and
firefighters should also be included in the strategy, while Kingston
director Lois Burrows asked how the board would track whether the
strategy was effective.

Huras said such monitoring would be added to the final plan, which
will be back before the board Aug. 25.

"The LHIN will work with providers to ensure that current resources
are being used as effectively and efficiently as possible to prevent,
treat, monitor and reduce harms related to opioid misuse," Huras wrote
in his report.

"Following approval of the strategy, LHIN staff will work on an
implementation framework and three-year implementation plan in

The strategy uses guidelines developed by the Kingston health unit in
co-operation with LHIN representatives and specialists in both
addictions and pain treatment.

It recommends non-opioid therapy, including exercise and other
painkillers, be used before prescribing opioids.

Opioid prescribing should begin with the least potent drug and at the
lowest possible effective dose - and for the shortest duration necessary.

Lost, stolen or destroyed prescriptions should not be refilled, the
document recommends.

Once the strategy is approved, LHIN staff will work with Ontario's
health ministry and public health on a three-year implementation plan.
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