Educating Family Physicians on Treating Patients with Addiction Disorders
A new curriculum is teaching family medicine residents about the treatment of addiction disorders, including alcohol and cannabis use, and safer opioid prescription.
Now in its pilot stage, the “Addictions 101 for Primary Care” curriculum is taught in two parts: online modules and case-based discussions. The modules are hosted on the Addictions 101 website and provide residents the opportunity to explore topics in addiction treatments. They are then able to apply their learning during face-to-face problem-based sessions with their educators and peers and discuss potential treatments to addiction issues.
"The issue of treating addictions tie in a great deal to mental and physical health needs,” says Dr. Jennifer Wyman, a family physician at Women's College Hospital and lecturer at the Department of Family and Community Medicine (DFCM). “We manage all of these issues in primary care, yet we somehow feel that they often need to be treated by a specialist.”
Through the course of completing her Masters of Public Health, Dr. Wyman developed an interest in educating physicians about the management of addiction and harm reduction. She says that there is a lack of knowledge and awareness among physicians in managing patients who have specific, yet very universal needs in overcoming addictions.
Building on her own and other’s work in addictions, Dr. Wyman created the curriculum to help residents recognize that addictions are chronic conditions that all family physicians can treat within their practices. A family physician who is aware of a patient’s other health issues and family history, she says, can often consider their addiction as one of the conditions that make up their overall health profile.
There are multiple scenarios that could prevent patients from receiving appropriate treatment for addictions issues. Sometimes patients seek care outside of their primary care setting and, without proper communication, could be on medications that are not properly monitored, or are inappropriate for their other health conditions. In other cases, a physician may not have the knowledge of what to do once a problem is identified. In some instances, the condition may not be recognized at all.
“Family physicians might not be experts in diabetes, but we don’t send all of our patients to specialists,” says Dr. Wyman as an example. “We still manage what we can within primary care. Even if we do send them to a specialist, they still come back to us for the rest of all their care. The idea was that a chronic condition like alcohol use disorder should also be monitored in the context of the patient’s whole care.”
Markham Stouffville Hospital, Sunnybrook Hospital and Southlake Regional Health Centre are all currently piloting this curriculum. Staff physicians are the local champions and trainers of the program.
“We hoped that by giving family residents concrete tools for practice, they would be able to both implement the screening and plan. This might involve suggesting simple, straightforward strategies they could manage within a family practice or referring patients who need more complex care to specialists.”
Currently, the team is planning the expansion of the program from the pilot sites to other DFCM training hospitals and are continuing to add more useful resources and tools as they become available to the website.
Dr. Wyman is also working to develop online education modules for physicians on safer opioid prescribing and opioid use disorders as part of a project funded by the Ministry of Health and Long-Term Care. The project falls under the Ministry’s opioid strategy of providing educational tools to help physicians navigate the complexity of opioid prescribing, managing chronic pain and management of opioid use disorder.