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Reflections Upon My Daughter's Wedding Dealing with the Patient on Narcotics in the Brave New World AHS Narcotic Ordering

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Reflections Upon My Daughter's Wedding Dealing with the Patient on Narcotics in the Brave New World AHS Narcotic Ordering COMMUNICATING WITH PHYSICIANS IN ALBERTA September 2017 ZONE MEDICAL STAFF ASSOCIATIONS OF ALBERTA VITAL SIGNS OPIOIDS Reflections Upon My Daughter’s Wedding Dealing With The Patient on Narcotics in the Brave New World AHS Narcotic Ordering Initiative The Opioid Crisis: Community Collaboration for the Planning of Supervised Consumption Services AHS plans Supervised Consumption Services at the Sheldon Chumir The Opioid Crisis and What You Can Do About It Telephone Consultation for Opioid Dependence Therapy Medical Marijuana: Who, Why and How? Rapid Dissemination of Best Practices to Primary Care Providers Via Project ECHO NEW LOOK NEW SERVICES AT MARKET MALL Expanded services for faster, local access. Automated Breast Ultrasound Bone Scan with SPECT/CT Image-Guided Pain Therapy Fast, efficient technology for 3D Mayfair’s state-of-the-art GE Mayfair’s experienced team uses imaging of the whole breast to Discovery 670 nuclear medicine Ultrasound and X-ray guidance provide a clearer picture of dense camera provides exceptional, high- to best localize and treat pain. breast tissue. resolution, hybrid images to help localize specific areas of concern. 40 Ave NW N Mayfair Diagnostics Market Mall 333, 4935 - 40 Avenue NW Calgary, T3A 2N1 Shaganappi Tr. NW 49 St. NW SERVICES: ALL APPOINTMENTS: Bone Mineral Densitometry, 403.777.3000 Market Mall Breast Imaging, Image-Guided radiology.ca Pain Therapy, Nuclear Medicine Imaging, Ultrasound, X-ray 32 Ave. NW MEDICAL IMAGING REIMAGINED A CALGARY & AREA MEDICAL STAFF SOCIETY PUBLICATION September 2017 CAMSS EXECUTIVE President: Dr. Sharron L. Spicer – Contents: [email protected] President-Elect: Dr. Linda Mrkonjic – Reflections Upon My Daughter’s Wedding ................................................2 [email protected] Secretary-Treasurer: Dr. Davinder Sidhu – [email protected] Dealing With The Patient on Narcotics in the Brave New World ...............3 CENTRAL ZMSA EXECUTIVE President: Dr. Alayne Farries – [email protected] AHS Narcotic Ordering Initiative .................................................................5 Vice-President: Dr. Edmund Barker Secretary-Treasurer: Dr. Stephen Tilley – The Opioid Crisis: Community Collaboration for the Planning [email protected] of Supervised Consumption Services ........................................................6 EDMONTON ZMSA EXECUTIVE President: Dr. Randy Naiker – [email protected] AHS Plans Supervised Consumption Services at the Sheldon Chumir .....9 Vice-President: Dr. Ernie Schuster – [email protected] Past President: Dr. Shelley L. Duggan – The Opioid Crisis and What You Can Do About It ...................................10 [email protected] Secretary-Treasurer: Dr. Michael Jacka – [email protected] Telephone Consultation for Opioid Dependence Therapy .......................12 NORTH ZMSA EXECUTIVE Acting President: Dr. Sandra Corbett (in acting role until Medical Marijuana: Who, Why and How? ................................................14 ZMSA is set up and ZMSA executive elected) Rapid Dissemination of Best Practices to Primary Care Providers SOUTH ZMSA EXECUTIVE President: Dr. Fredrykka D. Rinaldi – Via Project ECHO ......................................................................................16 [email protected] Vice-President: Dr. Jessica Abraham – [email protected] Secretary-Treasurer: Dr. Carl W. Nohr – [email protected] CONTRIBUTING WRITERS Dr. Alayne Farries Dr. Sheila Eleason Save the Dates! Dr. Brian Knight Dr. Peter Jamieson Dr. Nicholas Etches CAMSS Dr. Van Nguyen Council Meeting: September 13, 2017 | FMC Boardroom 152 – 5:30-8:30 pm Dr. Kimberley Kelly Dr. Michael Trew Zone Advisory Forum: October 11, 2017 | Southport Tower Room 1003 – 5:30-8:30 pm Dr. Ruth E. Dubinr Annual General Meeting: November 8, 2017 | The Glencoe Club – 5:30-9:00 pm MANAGING EDITOR: Hellmut Regehr, [email protected] Council Meeting: December 13, 2017 | FMC Boardroom 152 – 5:30-8:30 pm EDITORIAL ADVISORY COMMITTEE: Dr. Sharron Spicer – [email protected] Adrienne Wanhill – [email protected] Hellmut Regehr – [email protected] CZMSA Dr. Tobias Gelber – [email protected] Executive Meeting: September 14, 2017 | WebEx Dr. Steven J. Patterson – [email protected] Dr. Alayne Margaret Farries – [email protected] Zone Advisory Forum: October 12, 2017 | Red Deer – 7:00-9:00 pm Zone Medical Staff Associations Executive Meeting: October 12, 2017 | Red Deer Mailing Address: 350-611 Meredith Road NE, Calgary, AB T2E 2W5 | Reception: Suite #310, 611 Meredith Road NE, Calgary, AB T2E 2W5 Executive Meeting: November 9, 2017 WebEx COORDINATOR: Adrienne Wanhill 403-205-2093 Zone Advisory Forum: November 23, 2017 | Red Deer – 7:00-9:00 pm SUBMISSIONS: Executive Meeting: December 14, 2017 | WebEx Vital Signs welcomes submissions (articles, notices, letters to the editors, announcements, photos, etc.) from physicians in Alberta. Please limit articles to 1000 words or less. EZMSA Please send any contributions to: Spindrift Design Studio Inc. September 14, 2017 | Misericordia, 5:00-5:30 pm Hellmut Regehr, [email protected] Executive Meeting: | Vital Signs reserves the right to edit article submissions and Council Meeting: September 14, 2017 Misericordia IN-106, 5:30-7:30 pm letters to the editor. Zone Advisory Forum: October 19, 2017 | Misericordia IN-106, 4:00-7:00 pm The deadline for article submissions for the next November 16, 2017 | TBD, 6:00-9:00 pm issue of Vital Signs is September 15, 2017. General Meeting: CONTRIBUTORS: The opinions expressed in Vital Signs do not necessarily reflect SZMSA the opinions or positions of CAMSS or CAMSS executive. Council Meeting: September 11, 2017 | Teleconference, 5:30 pm ADVERTISING: Please visit http://albertazmsa.com/vital-signs/ to view media kit Annual General Meeting: November 6, 2017 | Medicine Hat, 5:30 pm or contact Hellmut Regehr at [email protected]. Zone Advisory Forum: November 6, 2017 | Medicine Hat, 6:30 pm Claims made in advertisements are not verified by CAMSS and CAMSS assumes no responsibility for advertising accuracy. © 2017 ZMSAs – Communicating With Physicians in Alberta 2 Dear Readers: We hope you enjoy this edition of Vital Signs. Many of our articles this month deal with the issue of opioids. A number of colleagues have shared with me their concerns about opioids and I’d like to share with you one of these thoughtful conversations. Dr. Sheila Eleason is a family physician in Red Deer who had an opportunity to reflect on her career while at her daughter’s wedding. She’d shared these reflections in the Red Deer doctors’ lounge and kindly agreed to print them in Vital Signs. We suspect there are many of you sharing your reflections in doctors’ lounges throughout Alberta. Please write us if you wish to share them with Vital Signs. Dr. Alayne Farries Dr. Alayne Farries, CZMSA President Reflections Upon My Daughter’s Wedding Dr. Sheila Eleason Hard to believe it has been over 26 years since she was born. I don’t feel particularly older than I did then (with a newborn and a toddler and over 2 years sleep deprived). Well, some of the joints have noticed. Then I think about some of the changes in health care. In 1991 NRP tions are likely to be directing or using other substances. I, for the (Neonatal Resuscitation Program) was new. Hepatitis A vaccine was most part, know which of my patients have ongoing problems with new. Treating asthma with steroids early to reduce inflammation recreational drugs, recreational use of prescription drugs, diverting and remodeling was new. (Five years earlier, in training, I remember drugs for profit and being caught up in the “party scene”. Tragically, sitting at an asthmatic’s bedside, coaching their breathing, in the middle I have lost patients to presumed (but likely) fentanyl overdoses in the of the night, waiting for them to go into failure from exhaustion or last 18 months. None were a surprise, all were sad. have cardiac arrhythmias from the theophylline drip, so I could call I actually had a chance to discuss this recreational use of fentanyl ICU! To the trainee, this left emotional scars). Things have changed. (which is an interesting drug, with significant concerns used medi- In the 1990’s, I, along with the other family doctors who do chronic cally — respiratory suppression, see 5-10 years ago with the warnings to care, were being vilified as being not compassionate by withholding not use fentanyl patches with opioid naïve patients) with a young man and restricting opioids for patients with chronic pain. We were who is a career dealer. He was experiencing complications of use of told the long acting opioids would minimize addictions as patients “crystal meth”, which he said he would never get into again, but that would not be getting the on/off effect. We were told that chronic “(he) wasn’t crazy and would never (himself) use street fentanyl”. This pain is disabling and chronic pain treated by opioids would help young dealer related that he had personally saved the life of 2 clients people with these conditions be more functional in life. I, like many the previous week with NARCAN® (naloxone HCl) kits. He shook of my colleagues, worked hard to help these patients achieve this his head and told me that the information is out there that this is pain-controlled higher functioning. I would have to agree that I dangerous (he informed me that the batch of powder he gets can be 200x have not been impressed over the long term. I would have to agree difference in potency in scoops right beside each other) but the danger with the research which has found that chronic pain is chronic, and appears to him be part of the appeal “like playing Russian roulette”. patients can have chronic pain with or without opioid’s side effects My perception of this “opioid crisis” is that there is a media and reg- and risks. The use of opioids has not gotten rid of chronic pain. ulatory wish to blame the well intentioned attempts by chronic care On the other hand, we are now being vilified for giving out opioid pre- physicians and pain clinics all over (who give tools for relief of chronic scriptions for chronic non-malignant pain.
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