Prescription opioid misuse and dependence has become an increasing problem and is linked to an array of negative consequences including addiction, overdose, and mortality. Although most chronic opioids are prescribed in the community, use in hospital and on discharge significantly increases the risk of chronic use and is often the first point of use for previously opioid naïve patients. While the use of high dose opioids in hospital can increase the risk of adverse events and length of stay, untreated pain continues to remain an issue for many patients, and finding the balance of managing pain while using opioids as safely as possible remains an ongoing struggle.
The Opioid Stewardship Program at St. Paul’s Hospital is a systems-level intervention developed to address this ongoing gap in care. Implemented in January 2020, the opioid stewardship clinical team consists of a clinical pharmacy specialist and addiction medicine physician who review and assess patients throughout the hospital and provide recommendations to improve the use of opioids. The program also addresses system wide prescribing through education, review of hospital policies and order sets, research, and quality improvement projects.
The goal of the Opioid Stewardship Program is to improve opioid prescribing, utilization, and monitoring at SPH in order to prevent or reduce adverse events, risk of inappropriate long-term use and dependence, and improve or maintain adequate pain control.
What started as a pilot project through partnership between Providence Health Care and the BC Centre on Substance Use, the Opioid Stewardship Program is now a permanent fixture at St. Paul’s Hospital thanks to funding and support from the Department of Medicine.
Lianping Ti, Research Scientist – BC Centre on Substance Use
Mike Legal, St. Paul’s Hospital Pharmacy Manager
Seonaid Nolan, Head Interdepartmental Division of Addiction Medicine and Physician Lead – Opioid Stewardship Program
Stephen Shalansky, St. Paul’s Hospital Pharmacy Clinical Coordinator
"We have a responsibility to make sure when we prescribe opioids, every prescription is as safe and effective as possible. That’s what this program is all about." – Dr. Seonaid Nolan
"I was extremely hesitant to get help from the St. Paul’s Opioid Stewardship Program. I had traumatic experiences before with doctors making me feel horrible, cutting off my meds too quickly so I’d go into withdrawals, and just making me feel like something was wrong with me. I took a chance on the Stewardship program, and was very glad I did. I got the help I needed, a very reasonable slow taper off my meds, no withdrawals, and full of support. Not once was I meant to feel the stigma surrounding chronic pain and opioid use. I’m now free of all pain meds, and am very grateful from the support of the Opioid Stewardship team. I would 100% recommend this to anyone struggling."
"The idea of getting off of hydromorphone seemed impossible. I went from a place of taking oral hydromorphone and experiencing micro-withdrawal multiple times a day, and spending more than 60% of my day staring at the clock to see when my next dose was, to now having a medication that I take once a day and don't have any issues with pain or withdrawal. It was like day and night. It was so important to me and my family. I wasn't even able to engage with my children before because of the withdrawal and my children didn't understand why. We are so grateful for this program, it is truly invaluable for me and so many other people who are struggling. It was only with the expertise of the Opioid Stewardship pharmacist and the Addiction doctors, and taking the time to review all of the options and make a decision together that I was able to make this big change. If someone asked me if this program should continue, I would say that it is a no brainer and that this one small program can make a big difference"