Over the past two decades, Canadians’ use of opioid analgesics has substantially grown, making the nation the second-largest user of opioid analgesics after the U.S. Despite the pressing need for treatment, opioid agonist therapy (OAT) training is not consistent nor required in all Canadian family medicine programs.
Family physicians in Canada can prescribe methadone and other opioid agonists but not enough of them do so. We need more willing prescribers.
Thus, improved learning opportunities must be deployed to scale up the OAT prescriber workforce now.
How was the study done?
We asked twenty family medicine residents in British Columbia, Canada, about their experience with and willingness to enroll in OAT training. We used the Consolidated Framework for Implementation Research to organize their responses.
Listen to a recent podcast where the lead author, Shawna Narayan, talks about the study:
What did the study find?
The medical residents spoke about: (1) challenges to training implementation, (2) feelings and attitudes on prescribing practices, (3) helpful learning spaces and places of substance use training, and (4) recommendations for implementing training.
Preparedness, exposure, and supportive learning environments for substance use education increased willingness to pursue OAT accreditation.
Ineffective learning experiences, mixed feelings about opioid prescribing, and lack of protected time were the most common reasons for unwillingness. One medical resident even said that they were “opioid-a-phobic.”
Practice points
- Effective medical education is needed to develop the skills of incoming family physicians to treat opioid use disorder and chronic pain.
- There are factors that influence residents’ willingness to undertake training in opioid agonist therapy (OAT) and pain management.
- Protected time for an accredited OAT program and diverse clinical experiences may increase residents’ willingness to complete training.
What would an ideal training program look like?
Based on our conversation with 6 St Paul’s hospital residents (R2), the ideal components of an opioid agonist treatment accreditation program would have the following:
Evidence-based review of guidelines to provide a solid foundation for experiential learning;
A balance of experiential learning with class-based learning;
Both inpatient and outpatient experiences related to caring for patients who use substances;
Experiences with providers who are expanding the scope of guidelines for treating different populations that require an outside-the-guidelines approach;
Protected time to complete the accreditation program.
Cited study: Narayan, S., Brath, H., Di Marco, D., Maclure, M., McCracken, R., Klimas, J. (2023) I’m almost opioid-a-phobic: Family medicine residents’ perceptions of enhancing opioid analgesic and agonist treatment training in a Canadian setting. Education for Primary Care (Early Online) 10.1080/14739879.2023.2204310
If you enjoyed reading this post, you may also like reading more about opioid research. Or, visit the REDONNA study at Dr Rita McCracken’s home page.