Dr. Nikki Bozinoff
Family Doctors at the Frontline of the Opioid Crisis With the number of deaths relating to the misuse of opioids steadily increasing each year across Canada, the medical community has been grappling with how best to handle this new epidemic. It is not straightforward: the factors leading to the epidemic, including the over-prescribing of opioids and an increasingly toxic illicit drug supply, and the ways to overcome it, are complex. Thankfully, there are many health care professionals specializing in addictions medicine that are trying their best to give doctors, including family doctors, the skills they need to reduce their opioid prescribing and develop new ways of treating patients struggling with substance use disorders. “It wasn’t that long ago that many family doctors felt that substance abuse should not be part of their practice – that treating people with addictions is not the role of the family doctor,” says Dr. Nikki Bozinoff, a family and addiction medicine doctor practicing in Toronto and program director of Enhanced Skills in the Addiction Medicine Program at the University of Toronto Department of Family and Community Medicine. That has changed over the past decade or so, she says, as addiction medicine has become part of the education offerings at medical schools, and as the science behind addiction medicine has become stronger.
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“It’s the opioid crisis that’s pushed many family doctors to seek out further training in substance use disorders,” says Bozinoff. “Because the patients are now showing up in their practice. They are increasingly confronted with how to manage it.” “In fact,” says Bozinoff, “family doctors are in many ways best positioned to offer first-line treatment of patients with substance use disorders, including those with opioid addictions.” “Family doctors are the face of health care; they are the ones that are quite well placed to diagnose opioid use disorder and other substance use disorders in communities. They often get to know their patients because of their long-term relationship, so patients may trust their family doctors more than others.” Through in-person and online training, Bozinoff and many of her colleagues are working to give family doctors and family doctors-in-training the tools and skills they need to feel confident in treating those with substance use disorders and managing first-line treatment, including prescribing medications like buprenorphine and methadone, both of which are long-acting opioid drugs used to stabilize and treat opioid addiction.