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Opioids are powerful medications that relieve all kinds of pain. But they are also highly addictive and an overdose is very serious, so prescribing them can be complex and challenging for physicians.
A new app, developed at Toronto Rehab-University Health Network, helps doctors decide whether to prescribe opioids and makes it easier to monitor patients taking these drugs for chronic non-cancer pain, such as osteoarthritis and low back pain.
Called Opioid Manager, the app for iPhone and iPad users was launched September 20, 2012. "This will help health care professionals apply the latest practice recommendations when prescribing opioids," says Dr. Andrea Furlan, the Toronto Rehab-UHN scientist and clinician who created Opioid Manager.
"If physicians select the right patients before they write the first prescription for opioids, then there will be fewer complications later on, such as problems with stopping."
The stakes are high. Canada is the second largest per capita consumers of opioid painkillers – drugs such as morphine, codeine and oxycodone. An alarming misuse of these medications has resulted in overdose deaths, dependency and addiction. "The misuse is not only by people who illegally obtain these drugs, but sometimes by those who obtain prescriptions," says Dr. Furlan.
By one estimate, reported this year in the Canadian Medical Association Journal, up to 200,000 Canadians are addicted to pain relievers – and the number of Ontarians seeking treatment for abuse of prescription opioids has doubled since 2005.
The new app captures key information from the 2010 Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain that includes 24 practice recommendations for doctors. "We see this app as a practical way to help doctors follow the recommendations contained in that 180-page Guideline," says Dr. Furlan, who led the research team involved in the guideline's development.
The Opioid Manager app is unique because of its sophisticated interactive features, she says. For example:
Before writing the first prescription, doctors can use a touch screen to answer a series of questions about a patient. The app informs the doctor which risk factors are present or not. The doctor can use this information to determine who is at risk of overdose and addiction.
An initiation checklist helps doctors ensure they cover key areas with a patient. These include: explaining potential benefits and risks, setting realistic goals (such as when to return to work) and providing the patient with information, such as the importance of locking up opioids at home so that the drugs don't fall into the wrong hands.
A conversion calculator shows the morphine equivalent (a standard unit for comparison purposes) for different opioids. It tells the doctor if he or she is prescribing above the 'watchful dose' – the dosage at which chronic non-cancer pain can be managed effectively in most patients. The app also calculates equivalent dosage when doctors are switching opioids.
Doctors can complete a maintenance and monitoring chart during every patient consultation, noting complications, side effects, and aberrant behaviour that can indicate a patient is on the path to addiction. There's also guidance on when and how to decrease or stop opioids.
The app is designed to encourage dialogue between doctors and patients on the topic of opioids. "Patients want to participate and to understand why their doctor is comfortable giving them opioids – or why it might be better to explore alternatives," says Dr. Furlan.
There's also a hands-on feature for patients. By dragging a finger over a face on the screen, patients can indicate the intensity of their pain. The angrier and redder the face becomes, the worse the pain.
While there are several opioid apps on the market, none is highly interactive, says Dr. Furlan. Information entered into the app can be emailed to a patient's chart. Importantly, patient names are not stored in the app or on the device.
The app received positive reviews when recently tested with doctors, and steps are underway to adapt it for the U.S., says Dr. Furlan, who is also an associate scientist at the Institute for Work and Heath and a University of Toronto assistant professor of physiatry. She received a CIHR New Investigator Award in 2012.
The new app is a technology-based, interactive version of a paper tool, also called Opioid Manager, developed by Dr. Furlan in 2010, with the Centre for Effective Practice. The paper tool is endorsed by the Colleges of Physicians and Surgeons in all provinces and territories, and by the Ontario Ministry of Health and Long-Term Care.
Funding to develop the paper tool and app was provided by the Ontario Ministry of Health and Long-Term Care through the Academic Health Science Centre Alternative Funding (AFP) Innovation Fund. U.S. physician Dr. Lynn R. Webster developed the opioid risk tool, included in the Opioid Manager.
The Canadian Opioid Guideline was published by the National Opioid Use Guideline Group, and the Michael G. DeGroote National Pain Centre has responsibility for its stewardship.
Watch the Opioid Manager app video here.
For more information, visit www.opioidmanager.com.
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