Saturday, December 3, 2016

Fall/Winter 2016 Issue of ACE Newsletter

Volume 13, Number 2 Fall/Winter 2016(pdf)

  • Pharmacy Services in Long-Term Care Homes
  • Privacy Act and Old Age Security Benefits
  • Patient-Centred Care: "Wishes" Are Not Consents
  • Case Comment: Andrade v. Andrade: A Purchase Money Resulting Trust
  • Quality and Accountability in Health Care?  Ontario's Patient Ombudsman and Bill 41, Patients First Act
  • ACE Celebrates Judith Wahl, Past Executive Director of ACE

Monday, November 28, 2016



When: Monday, January 9th to Sunday, February 5th, 2017 (4 weeks)
ONLINE weekly at your discretion
Cost:  $240 (Students/Seniors $120) 
Registration Deadline:  January 2nd, 2017 
This workshop will be offered only if there is sufficient enrolment.
Register online at
Course Objectives:
•    Become familiar with differential approaches for concurrent disorders
•    Be able to screen for addictions in older adults
•    Develop skills to recognize types of addictions in older adults
•    Be able to use geriatric, addiction-specific assessment tools

Week 1:  Addictions Overview

    Types of addictions in geriatric populations
    Stigma and barriers to treatment
    Rationale for specialized treatment
    Principles of harm reduction

Week 2:  Assessment - How to ask the questions no one wants to ask
    Screening
    Assessment
    Geriatric specific tools

Week 3:  Theory and Practice
    Stages of Change Model
    How to work with the pre-contemplative patient
    Counselling techniques

Week 4:  Harm Reduction and Treatment Approaches with Special Subgroups
    Alcohol induced dementia
    Acquired brain injury
    Co-occurring mental health and addictions

Instructor:      Marilyn White-Campbell, B.A., Dip. Grt
Marilyn is a geriatric addiction specialist and a Canadian Pioneer in the field of addictions treatment for older adults.  As clinician and educator and researcher for over twenty five years, Marilyn works with concurrent disordered older adults in the community and in long term care.  She is currently on Secondment to the Wellington Waterloo LHIN to build capacity in geriatric addictions in collaboration with COPA, CMHA Specialized Geriatric Services and SJHC Guelph    Behavioral support team.   She is  Co-author of Addictions Treatment for Older Adults, she has presented nationally and internationally on the treatment of older adults with substance use disorders, and is the recipient of the Ontario Psychogeriatric Award of Excellence in 2011,  nominated for the Service Awards  for  Geriatric Excellence ( SAGE)  in the  category of  Executive  Senior Leadership Achievement  in  2015 and for  Team excellence  in 2016..  She is the founder of the COPA College © program, a group based model of care and co-author of two physician pocket guides for the treatment of substance use disorders in the elderly.

Registration and payment available online at

Saturday, November 12, 2016

Dying With Dignity: we need information

The numbers are important.

More than 100 Canadians have opted for assisted death since law passed
Federal government is required to record assisted deaths but has yet to begin tracking numbers
Doctors and nurse practitioners have helped hasten the deaths of more than 100 Canadians since the federal law governing medical aid in dying was passed in June.
The actual number of deaths is probably significantly higher because several provinces could not, or would not, provide complete data. Quebec, which was the first province to adopt a law on doctor-assisted death, provided no data whatsoever.
CBC News obtained data under the Right to Information Act after the province declined to provide numbers

CBC News has learned Horizon Health Network, the province's English health authority has approved nine doctor-assisted dying cases, a number that was kept secret until now.
The data was obtained through the Right to Information Act after the province declined to provide records, citing privacy concerns.
Nova Scotia and the Yukon were the only other province and territory that didn't provide the information to CBC News.

Thursday, November 10, 2016

ODPRN report on opioid use and adverse events in Ontario

These results, by Ontario County, reflect non-cancer pain medical situations.

These numbers reflect only people covered by the Ontario Drug Benefit Program: seniors, ODSP clients, Trillium, Ontario Works, LTC residents, Home Care patient recipients.

 Over the past two decades there has been growing concern about the rising use of opioids – and high strength opioid prescribing in general – to treat chronic non-cancer pain (CNCP). Furthermore, the rising prevalence of abuse, misuse and addiction related to opioids has driven concerns regarding accidental opioid overdoses that may lead to hospitalizations for toxicity, and sometimes death.
ODRPN has done a fabulous job isolating rates of Opioid use by county and LHINs.

Thursday, November 3, 2016

Protect yourself!

Sunday, October 23, 2016

Opioids in Canada

  1. Public health emergencies must be declared more liberally. 
  2. Ongoing, coordinated surveillance. 
  3. Naloxone – freely available
  4. Supervised drug consumption services
  5. Medications for opioid addiction
  6. We must address overprescribing of opioids.
  7. Drug use should be considered a public health issue, not a criminal one.

Fentanyl front lines: Fentanyl-linked deaths triple this year

There have been 555 deaths as a result of illicit-drug overdoses from January through September, eclipsing the 508 drug-related deaths in B.C. in 2015.
The total number of illicit-drug overdoses in September was 56, up from 49 in August, according to the latest statistics released Thursday by the B.C. Coroners Service.
The powerful opioid fentanyl was detected in 302 deaths — 61 per cent of all drug deaths from January through August this year —more than triple the number of fentanyl-related deaths compared with the same period last year.

A summary of ODPRN research on prescription opioid use in Ontario
Click through our Interactive Map on opioid prescribing and
opioid-related hospital visits in Ontario
From 2008 – 2015, the ODPRN conducted several population-based studies to investigate the use of opioids in Ontario. The key objective of these studies was to provide evidence to inform discussion regarding the safe and appropriate use of opioids.
This report summarizes these findings as well as policy and practice implications into four key themes of our research:
  1. Overall trends in opioid use are increasing in Ontario, particularly at doses that exceed guideline recommendations
  2. Safety of opioid use, particularly at high doses, is related to serious adverse events, including risk of overdose death and road trauma
  3. Geographic variation in opioid prescribing, use and safety is apparent and should be considered when designing public health and policy initiatives
  4. The impact of policy and education interventions is varied and will need to involve a combination of regulatory/legislative changes, as well as patient and clinician education to respond to this ever-shifting prescribing environment
View a copy of the ODPRN’s new public report.

Canada is the world’s second-largest per capita consumer of opioids and the fallout is being felt across the country. Last week, a report found that from 2009 to 2014, at least 655 Canadians died as a result of fentanyl, a powerful opioid that is available by prescription and is also manufactured in clandestine labs and sold on the street. Opioid overdose deaths continue to rise across Canada, forcing federal and provincial authorities to respond to this growing epidemic. In Ontario alone, these drugs have killed nearly 2,500 people between 2011 and 2014.

Thursday, October 20, 2016

Patient Engagement for Quality Improvement


Quality standards are a go-to resource for quality care. They are concise sets of easy-to-understand statements based on the best evidence.
Quality standards will:
  • Help patients, residents, families, and caregivers know what to ask for in their care (patient reference guides)
  • Help health care professionals know what care to offer, based on evidence and expert consensus (clinical guides)
  • Help health care organizations measure, assess, and improve the quality of care they provide
  • Help ensure consistent, high quality care across the province so that all Ontarians receive the best possible care.

Wednesday, October 12, 2016

Opiod overdoses: Ontario Strategy

Conclusion: This study suggests opportunities for improving OD outcomes. Those who receive higher quantities of prescription opioids concurrent with other psychotropic medicines may need closer monitoring to avoid death, repeated OD events, higher service use, and higher service costs. Other opportunities for improving OD outcomes include the use of electronic health records to notify physicians of high-risk patients and updating of guidelines/operation manuals focused on the distribution of naloxone to those in highest need.

The measures include expanding access to Suboxone, which helps treat opioid addiction by stopping cravings and preventing withdrawal symptoms. The drug is considered safer than methadone, with "significantly less" risk of fatal overdose, according to information from the Ministry of Health and Long-Term Care.
The province has just added the drug to its Drug Benefit Formulary. Adocument from the Ministry of Health and Long-Term Care shows that Suboxone in 2 mg and 8 mg strengths has been changed from "limited use" to "general benefit" on the formulary.

Thursday, September 29, 2016

Reports on Aging; treatment plans

This is a bit simplistic, however, they are good questions to ask both your doctor, or perhaps your pharmacist.

I prefer that patients ask more overarching questions, such as the overall treatment plan.
This list is appropriate for all patients. 
  1. Write down symptoms, use an agenda, notebook or planner, filling extra notes. 
  2. Save the list from the pharmacy, which lists all of your prior medications. Tape it into your agenda.
  3. Write down all over-the-counter medications. They may be important, including vitamins and other supplements, e.g., creams, herbs, lotions.
  4. Create questions for your doctor. They may include: 

  • What might be causing my signs and symptoms? 
  • Are tests needed to confirm the diagnosis? 
  • What treatment approach do you recommend? 
  • What are the side effects from this treatment?
  • What are the alternatives to the primary treatment approach that you're suggesting? 
  • What health routines do you recommend to improve my symptoms?
Click images to access the resources on 5 Questions to Ask your Doctor 
Medication Questions

WHO Report on Aging and Health

Further Reading