Toronto hospital has unique strategy to reduce opioid abuse

Helping patients find alternatives to opioids before they become dependent is a pioneering strategy at a Toronto hospital that is now drawing interest from hospitals across Canada.

The transitional pain service at Toronto General Hospital is aimed at patients who've had surgery.

"Seventy per cent of the patients we see have a chronic pain problem before surgery. So they're already on high levels of opioid medication even before they have the surgery. After surgery, it's going to be even higher. So we want to come in to give them all of the options for managing that pain," said psychologist Dr. Aliza Weinrib, who works at the clinic.

The alternatives to opioids include combinations of physiotherapy, meditation, acupuncture, and counselling, among other techniques for pain management.

Toronto artist Michael Satok Wolman sought the help of the pain service following surgery for stomach damage, resulting from long-term abuse of different painkillers.

At the time of his admission he was using five times the recommended limit of opioids, which had been prescribed by his family doctor.

"I had to come to grips with the fact that I was an addict and that I had been an addict for over 30 years," he said.

Today, Satok Wolman manages his pain without opioids, though he's prescribed Suboxone to help with his withdrawal symptoms.

Nearly 13 per cent of patients in Canada are already on an opioid for a chronic pain diagnosis — a risk factor for chronic post-surgical pain that costs more than HIV, heart disease and cancer combined annually, said Dr. Hance Clarke, director of the transitional pain service. "Pain is a silent epidemic," he added.

Clarke said he tries to get patients to separate pain relief from their dependency on painkillers.

"If you're telling me today that your pain is nine out of 10 and your pain was nine out of 10 [back] 25 years ago … the effectiveness is gone. So let's start looking at solutions and how we move forward. And Michael [Satok Wolman] was strong enough to say that he does have an issue here, let me try something different, and now he's been able to change his course," he said.

The transitional pain service has seen approximately 400 patients since it opened its doors in 2014. Clarke said other hospitals are interested in "templating" the clinic's strategy. He also wants to initiate a comparative study to verify its efficacy.