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All practice improvements require changes to be implemented.  The opioid change package is intended to help physicians and team members implement practice changes that improve care for patients who use opioids. The change package tools were designed to work best in conjunction with quality improvement training to maximize the impact. You can register for training online here.


The potentially better practices listed are derived from a review of the literature, clinical practice guidelines, and from expert recommendations. They are anticipated to improve the care of patients who are using opioids. However, the list of practices is not exhaustive and should be customized, tested, and evaluated in your own clinical setting before you will know whether they are truly "better".

BradBahlerphoto.jpg"The specialty of family medicine is built on relationships physicians and teams have with patients. Those relationships open windows to our patient's lives and often trigger discussions around difficult topics including pain and opioid use. As we continue to battle the opioid crisis in Canada, thanks to you and your teams for continuing to work with those using opioids and those at risk who may be initiating opioids. Learning how to structure our team based approach to this complex population moves us yet another step along the path to Patient's Medical Home."

- Dr. Brad Bahler

Glossary and Acronyms


Opioids: A family of drugs that are usually prescribed to relieve pain. Examples include codeine (Tylenol No. 2, 3, 4), oxycodone, morphine, hydromorphone, and fentanyl.

Benzodiazepine: A family of drugs that are usually prescribed for anxiety, sleep or seizure disorders. Examples include Valium® (diazepam), Xanax® (alprazolam), and Ativan® (lorazepam).

OME (oral morphine equivalent) or MME (milligram morphine equivalent): OME or MME is a way to compare the analgesic (or pain relief) strength of different opioid medications.  Often it is calculated for a 24 hour period. It is determined by using an equivalency factor to calculate the dose of morphine that is approximately equivalent to the ordered opioid. For example, 100mg OME equals: 20mg hydromorphone, 65mg oxycodone, 25mcg/hr fentanyl.

OUD (Opioid Use Disorder): Clinical diagnosis characterized by a pattern of problematic opioid use, linked to clinically significant impairment in function, and may include any of the following: cravings to use opioids, continued use despite experiencing social or interpersonal problems, tolerance, withdrawal, and others.

OAT (Opioid Agonist Therapy): An effective treatment for opioid dependency. The treatment involves taking opioid agonist medications (e.g. methadone or Suboxone®) to prevent the withdrawal symptoms, reduce cravings and support stabilization

Suboxone®/Methadone: Medications that can be used for the treatment of opioid use disorder (OUD). Suboxone® is the brand name for a combination medication that includes buprenorphine and naloxone. It is a safe medication that can be prescribed and managed in the medical home. No prescribing course is required to maintain a prescription, however a treatment of OUD course is recommended for initiating a prescription. Buprenorphine is a partial opioid agonist which means it binds to the opioid receptor and has a small effect to prevent craving and withdrawal but doesn't cause the full effect of an opioid like the mood effects. Patients must be in mild-moderate withdrawal in order to start Suboxone®. Methadone is a long-acting opioid and therefore does not have the instantaneous mood altering effects of other short-acting opioids. Prescribers require additional training in order to prescribe and maintaining methadone. Patients do not have to be in withdrawal in order to start methadone.

Harm Reduction: Set of practical strategies aimed at reducing negative consequences associated with drug use (e.g. safe injection sites, needle recovery programs, OAT, Naloxone kits). The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself and the focus on people who continue to use drugs.

Naloxone Kits: A Naloxone Kit is also known as an Overdose Response Kit, or Take Home Naloxone Kit.  Naloxone is an opioid antagonist which means it binds to the opioid receptor but doesn't cause an effect. The kits are small, portable and can be used to respond and reverse opioid poisoning or overdose. Each kit contains:

·         3 vials of naloxone (each vial is 1 dose)
·         3 safety syringes
·         3 alcohol swabs
·         1 pair of rubber gloves
·         1 barrier mask (for rescue breathing)
·         An information pamphlet explaining how to inject naloxone

Dependence vs. Addiction: Dependence is characterized by the symptoms of tolerance and withdrawal, whereas addition is marked by a change in behavior caused by the biochemical changes in the brain after continued substance use. Different parts of the brain are responsible for each, thus it is possible to be dependent without being addicted.

Change Package: Consists of high-impact outcomes, potentially better practices and measures that when implemented bring about quality improvement. Key tools and resources are often linked to support the potentially better practices.