The opioid crisis: getting to “better”

Our best chance to have an effect is with intervention at the community level.

Retention while in treatment (86% vs 67%), street opioid abstinence (53% vs 35%), and patient satisfaction (77% vs 38% were very satisfied) were all better when care delivery was in primary care by primary care providers, as compared with specialty care.^2,3

Family doctors can and should play an important role in opioid agonist therapy.

The evidence for opioid agonist therapy benefit in the journey of recovery is strong.³ It can be done; it is not that complicated; and influencing the journey of recovery can be very rewarding. It is another example of community adaptiveness, as described in the Family Medicine Professional Profile.⁴

Don’t do this alone.

A critical mass of FPs, with support from other providers, where possible, facilitates the provision of good care and decreases the risk of burn-out. We need to work together to have a positive effect on the care of these complex patients. Several Chapters and provinces are implementing mentoring networks of providers. The Patient’s Medical Home⁵ also offers ways of implementing team-based and proactive care.

We should harness the power of influence and advocacy.

Several summit participants mentioned the 4-year election cycle, which might negatively affect funding dedicated to this particular care area; others reiterated the importance of a good marketing strategy in influencing public opinion (eg, an “I am in recovery, and I will vote” campaign to influence proposed health policy levers).

Appropriate compensation that recognizes the complexity of care for these patients is important.

Physician compensation was identified as a barrier. The CFPC has recognized the limitations of the fee-for-service model of payment in addressing the needs of those with complex conditions. We hope that, at a minimum, provincial medical associations prioritize alternate payment models to better meet the needs of those patients; failing this, a complex care fee code would be a welcome starting point.

The CFPC participates in the creation and dissemination of educational tools on opioid care (eg, special Self Learning issue on opioids).⁶ Additionally, clinical practice guidelines on OUD were published in the May 2019 issue of Canadian Family Physician.³ Most provincial Chapters include high-quality continuing professional development programs on opioids. And CFPC’s Certificate of Added Competence in Addiction Medicine can also be acquired by interested members. Meaningful sustained effects require the involvement of many partners working in concert to address this health emergency. We can and will do better.