What is being done to make opiates safer in hospitals, communities and correctional facilities?

Author: Crystal Clear Transitional Care Inc. |

Let us tell you the ways:

  1. We have returned the Opioid Manager (2011) back to McMaster University because there were ‘lethal’ flaws and gaps in this document;
    • We returned My Opioid Manager to authors owing to ‘deadly’ gaps and we request that you remove this link from your website;
    • We recognize that ALL of the methadone guidelines with the College of Physicians & Surgeons are flawed and ‘deadly’;
    • We recognize errors in the Canadian Diabetes Association (2013) guidelines for the treatment of diabetic neuropathy (Bril et al., 2013), and the 2018 Diabetes Canada guidelines.
    • We are not going to go with the 2017 Canadian guideline for the management of Opioids in Non-cancer pain;
    • We returned the FIRST DO NO HARM document (National Advisory Council on Prescription Drug Misuse, 2013) – flawed and deadly!
  2. We have ordered in Naloxone (Narcan) in the proper delivery device that would be suitable for ALL Canadians. We have rejected Alberta Health’s vile and syringe delivery devices for the community management of opioid overdose. It is unsafe and inappropriate. Canadians and ALL people deserve better quality healthcare delivery;
  3. We revised Canada’s Special Access program that was clearly outdated (2009);
  4. We have revised the American’s Advanced Cardiac Life Support Algorithm (ACLS) to include Narcan Nasal Spray as well as Flumazenil Nasal Spray (once available for the management of benzodiazepine overdose); and we have removed lethal drug-drug interactions with amiodarone using www.qtdrugs.org website. We are teaching paramedics to recognize opiate overdose in the community so they can administer the drug immediately. Further we are teaching paramedics an advanced skill (intraosseous access) so they can ensure you get adequate fluid resuscitation during an overdose event. We have also included ‘opiate overdose’ as a reversible cause of death so that we ensure all reversible causes are reversed so we do not take your organs prematurely;
  5. We have developed the Canadian Patient Safety methadone/opiate agreement as a measure of safety;
  6. We have revised the American Clinical Opiate Withdrawal Scale (COWS) as clearly there were gaps in this document;
  7. We have revised the Pain Medicine End of Rotation Evaluation Form: Psychiatry, Addiction and Sleep Medicine, Premature & Preventable Death, wrongful conviction;
  8. We revised Accreditation Canada’s (2014) Trauma Distinction Package and called it TRAUMA DISTINCTION PLUS™;
  9. We developed a Resuscitation of Shock Standing Orders;
  10. We revised Maslow’s Hierarchy of Needs – moving pain up the list. After breathing and fluid, pain takes priority as people will do without food and other necessities when they are in pain;
  11. We reviewed and developed a ‘Revised Set of Minimum Competencies for Medical Officers of Health in Canada’ – clearly many were not listening or understanding your needs;
  12. We UPDATED the Team Communication Extra-Mural to ensure nurses in the community review your pain medications and to ensure comprehensive pain management. We are also embarking upon physician-assisted death. Please try methadone, a potent pain medication, prior to opting for physician-assisted death. You must know ALL of your pain medication options to make an ‘informed’ choice;
  13. We revised the Sleep Apnea: Obstructive Sleep Apnea document so we do not confuse sleep apnea with opiate overdose. Many people die in their sleep;
  14. We developed a Comprehensive Medication Reconciliation Policy for hospitals and emergency departments. If you overdose once, you are HIGH RISK of overdosing again. A skilled healthcare provider will review your medications for lethal drug-drug interactions, they will determine if you have an underlying condition that would increase your risk of overdose (i.e. pneumonia, exacerbation of COPD, tuberculosis, constipation, sepsis, etc.), and you may need medication changes. This does not mean we are going to take away your pain medication. You may need to be changed to a different pain medication to better suit your needs;
  15. We have developed Removal of Endotracheal tube policy as a component of safe, competent, ethical prescribing practices. We will remember to turn off a fentanyl infusion so that you can breathe. If we forget, no worries. Our revised Advanced Cardiac Life Support (ACLS) algorithm will cover you;
  16. We answered the research question and determined an ECG Peri-Operative Cardiovascular Evaluation for Non-cardiac Surgery will be MANDATORY! We want to ensure every success during your hospital stay;
  17. We are DENOUNCING opioid detoxification as this is a ‘deadly’ practice as many have come to find out first-hand.
    • Further we have returned documents to healthcare providers that have not met our prescribing needs (Dara, 2014).
    • We are also speaking up about suicide in acute opiate withdrawal (Province of New Brunswick, Office of the Coroner, 2009);
  18. We developed the signs and symptoms of methadone/opiate overdose fridge magnet as clearly families have not recognized these signs (W5, 2015), and this has been a ‘deadly’ oversight as others have found out including 23-month old Dakota Rose Linfield (YouTube now removed from internet) and her father who received a two-year jail sentence. Many others have had these symptoms which may have been interpreted as congestive heart failure, or pneumonia. Healthcare providers will now consider opiate overdose as a differential diagnosis to congestive heart failure and/or community acquired pneumonia. When ordering a chest x-ray, your healthcare provider will be prompted to answer the question on your behalf: Is there an opiate on board? Please answer this question with utmost sincerity as your life is depending on it. This will prompt the radiologist to put on his/her ‘special reading glasses’ and properly diagnosis the chest x-ray. NOTE: Everyone is HIGH RISK for opiate overdose when they least expect (Dakota Rose Linfield, 2010). Inevitably people think: This will not happen to me. It is not until your dead that you realize it can happen to you;
  19. We designed a CODE BLUE fridge magnet to remind healthcare providers to consider all reversible causes before giving up on resuscitative measures. Opiate overdose has been added to the list. This magnet is intended for hospital crash carts, hospital bedside monitors, ambulances, physician/NP offices, etc.
    • The Bailey Bus is evidence of substandard healthcare delivery and will not be tolerated in Canada (Direction 180, 2015);
    • Insite ‘heroin injection’ in British Columbia is evidence of substandard healthcare delivery and evidence of healthcare ignorance. Methadone is the GOLD STANDARD in opiate addiction treatment.
    • Methadone is to be considered as a ‘cost-effective’ pain medication for the treatment of diabetic neuropathy which is clearly missing from the Canadian Diabetes Association guidelines for the treatment of diabetic neuropathy (Bril et al., 2013) but considered by the Americans as a treatment option (Chou et al., 2014; Hayes et al., 2005). Based on the near-death experience of a New Brunswick man, it’s time to consider alternative diabetic neuropathy pain options before cutting off limbs and before considering physician-assisted death;
  20. We changed the Methadone/Opiate Exemption to include nurse practitioners in the prescribing mix. Further methadone is to be considered prior to opting for Physician-Assisted death;
  21. We returned the Sepsis Algorithm – owing to lethal drug-drug interactions.
    • Anti-infective guidelines for community acquired infection returned to authors as they did not consider lethal drug-drug interactions with opiates; no consideration of www.qtdrugs.org website
    • Prescription drug misuse in Alberta. Everyone’s problem – returned to Alberta Health. Chief Medical Health Officer of Health unable to identify GOLD STANDARD care.
    • Returned National Advisory Council on Prescription Drug Misuse (2013) FIRST DO NO HARM – forgot to provide methadone treatment as a component of GOLD STANDARD care;
    • Alberta Poison Control specialist unable to recognise signs and symptoms of opiate overdose in W5 (2015) documentary: Kill Pill;
    • We returned Alberta’s Chest pain guidelines;
    • We have
  22. We revised PADIS – FAQ’s – Fentanyl was returned to Alberta Health Services owing to gaps in information.
    • Canadian Red Cross (2011) First and CPR manual outdated: flawed and deadly;
    • Canadian (2017) guideline for safe and effective use of opioids for chronic noncancer pain – returned to authors;
    • American (2009) guideline for safe and effective use of opioids for chronic noncancer pain – returned to authors – request for rewrite;
  23. We determined the Suspected Opioid overdose management protocol using naloxone – outdated, and flawed – does not assist children under 12 years;
    • Dakota Rose Linfield (YouTube Video removed from Internet). MYTH: Methadone treated no differently than any other narcotic – It is! See Methadone exemption, item #20;
    • Australia’s National guidelines for medication-assisted treatment for opioid dependence – returned to Australia.
    • OSCE and Clinical Skills handbook returned to Nova Scotia author owing to gaps in service (Hurley, 2005);
  24. We realize now that Order Matters when designing health promotion strategies
    • PREMATURE AND PREVENTABLE DEATH TRUMPS ALL HEALTH PROMOTION STRATEGIES – when you are dead nothing else matters, even climate control
    • See other important items
    • Need for comprehensive extubation checklist to ensure opiate infusion is discontinued prior to extubation;
  25. Opiates are transmitted in breast milk – don’t find out the hard way!
    • Stephanie Greene – sentenced to 20 years for death of baby ;
  26. We revised Nova Scotia’s Prescription monitoring program
    • The Joint Commission (2012) omitted to find gaps in ACLS algorithm;
    • American text book authors (text used in Canadian universities) omits to teach QTc interval and lethal drug-drug interactions or reference to www.qtdrugs.org website (Tortora & Derrickson, 2012).
    • World Health Organization does not consider countries like Canada do not have appropriate delivery devices for the community management of opiate overdose (WHO, 2014);
    • American Heart & Stroke Foundation CPR/First Aid guidelines (2015) Canadian Edition – missing signs and symptoms of methadone/opiate overdose; missing www.qtdrugs.org website/ missing naloxone in the prefilled syringe;
  27. We revised the Royal College of Physicians & Surgeons of Canada (2015) Accreditation standards for simulation programs revised and renamed: Canadian Accreditation Standards of Simulation programs.
    • Validated www.qtdrugs.org website
    • www.harmreduction.org website - missing pertinent signs and symptoms of opiate overdose
    • Organ donation and retrieval document missing opiate overdose as a reversible cause! (Shemie et al., 2006);
    • Validate that death investigation reform needed
      • Canadian Bar Association
      • Others wrongly diagnosed or not investigated (Dakota Rose Linfield, 2010);
  28. We developed the Comprehensive Peer Death Review form revised based on Inquest results;
  29. We designed a unique Doctor of Nursing Practice program – Made in Canada, eh? Taking Methadone/Opiate prescribing to an all new level: not too high, not too low, careful not to cross the line into corrections!
  30. We determined a ‘lethal’ drug-drug interaction with Benadryl and opiates: move Benadryl behind the counter so as to initiate a quick drug-drug review by pharmacists;
    • We determined that Taser research is flawed and deadly! (Bradshaw, n.d.; Canadian Academy of Health Sciences, 2013);
  31. We determined that the Accreditation of pain conferences needs to be taken up a couple of notches* based on evidence of premature and preventable death and wrongful conviction.
    • Calgary School of Medicine (2015). The Calgary Pain Conference;
    • Cumming School of Medicine (2015). Chronic pain management of the family physician;
    • Cumming School of Medicine (2016) Essential strategies for chronic pain management;
    • Revised and returned: CSAM position statement on opioid prescribing for chronic non-cancer pain (Kahan et al., 2011);
    • Returned job description to LifeMark for revision and reposting;
  32. We made changes to the Canadian Pain Coalition’s What about pain medication? (Canadian Pain Coalition, n.d.)
    • What about opioid-induced urinary tract infections?
    • What about the QTc interval?
    • What about opioid-induced anemia?
    • What about breast feeding while taking opiates long-term?
    • What about opiate overdose?
    • What is being done to make opiates safer in hospitals, communities and correctional facilities?
      • Note the ways
      • Advanced clinical practice research
  33. Returned Methadone Safety Guidelines (2014) – American Pain Society and/or Dr. Chou et al. (2014) – flawed and deadly
  34. Returned American Society for Pain Management Nursing Position Statement: Pain Management in Patients with Substance use disorders – flawed and deadly

We come to your community in person or via the internet. We give comprehensive presentations (Horizon Health Network, Board of Director Minutes), or we come to your community and give a quick lunch and learn (Alberta Health Services, Cochrane, AB). We speak at seminars (New Brunswick Lung Association) and distribute fridge magnets. We attend conferences (i.e. Critical Care Conference, Ontario; Trauma Association of Canada, Calgary) and we write a lot of letters, stamp out false information, identify gaps in service, stop false healthcare advertising, and other MYTHS (i.e. no one ever died from opiate withdrawal), and other healthcare nonsense associated with methadone/opiate prescribing.

As an alternative to organ donation and retrieval, we accept the patient’s file for clinical case review as a component of advanced clinical practice. We also attend inquests to determine if there is anything we could have done differently. We can do internet research if all else fails. We are critical thinkers and we practice ‘common sense’.

These are a few of the things we are doing to keep the patient experiencing pain and/or opiate addiction safe in our hospitals, communities and correctional facilities. We are hoping you will update the Canadian Pain Coalition website to reflect our current changes and that we healthcare providers are taking your concerns VERY SERIOUSLY. We have gone from a harm reduction/injury prevention model of care to a DEATH PREVENTION/WRONGFUL CONVICTION model of healthcare delivery. This is evidence of just how seriously we are taking your concerns. I think we got the picture and we definitely got your message. We also practice evidence-based medicine as indicated by the references below.

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