Thunder Bay

Marathon, Ont. clinic wins recognition for program aimed at safer opioid prescription

A clinic in a small northwestern Ontario town has taken an innovative approach to try to make opioid prescription safer, and it's winning some recognition for its efforts.

HARMS system won a Bright Lights Award from the Association of Family Health Teams of Ontario

The Marathon Family Health Team Chronic Pain and Addictions Committee. Left to right: Shelley Heavens, Michele Lajeunesse, Dr. Ryan Patchett-Marble, Elana Armitage, Dr. Nancy Fitch and Dr. Megen Brunskill. Missing from photo: Trixie Dykstra and Margaret Cousins (Marathon Family Health Team)

A clinic in a small northwestern Ontario town is enjoying some recognition after taking a chance on an unusual approach to opioid prescription.

For the past several years, the Marathon Family Health Team, located in Marathon, Ont., has required urine drug tests of every patient prescribed opioids for chronic pain.

The tests are used to better understand whether patients will be helped, or harmed by a prescription, said Dr. Ryan Patchett-Marble, a family doctor at the clinic and lead on the HARMS (or High-yield Approach to Risk Mitigation and Safety) program.

"There's no perfect test to show someone's in pain and there's no perfect test to show that somebody's addicted," he said. 

"There is something that can help us know, and that's urine drug testing." 

If the tests reveal traces of other concerning drugs — cocaine, for example, or opioids that were not prescribed — then doctors take note.

"Those things suggest the person's at higher risk of opioid addiction, overdose and death," he explained, "and so urine drug tests can help us know who we're harming, and affect [whether] we prescribe opioids at all, and if we do, how." 

While there was some initial pushback from patients worried that the drug testing may turn out to be punitive, over time that concern dissipated, Patchett-Marble said, as people came to understand that the tests were being applied across-the-board as a safety measure.

Drug test results changed care for one in five

The urine drug testing system was implemented about four years ago, but it was studied in 2016 and 2017 when a group of patients, considered to be low-risk, were followed over a 12-month period.

The study revealed that the system was having an even bigger impact than expected. 

It found that one in five patients had a drug test result that "directly changed management," meaning doctors altered the patient's care by starting the patient on addiction treatment, weaning them off medication or taking other measures. 

"I assumed it would have a high detection rate, but one in five is actually quite astounding because we'd already weeded out the people that were considered high-risk," said Patchett-Marble. "So we were quite surprised."

Provincial recognition

Others are now starting to pay attention to the HARMS system, and its potential, said Patchett-Marble, who recently gave a talk on the program at a family medicine forum in Toronto. 

This year it received an award from the Association of Family Health Teams of Ontario. The Bright Lights scalable pilot program award recognizes a project with potential for expansion. 

Expansion to other clinics is the next step, said Patchett-Marble, adding that they also plan to more thoroughly study the program and its impacts. 

"Up to this point, drug testing hasn't been studied very well, as it's used for chronic pain, and we'd like to, during this expansion, also evaluate and say 'hey, does this actually work?' 

"Does a clinic that does drug testing as a safety measure with opioids, do they have lower rates of addiction? Or higher rates of detection of addiction? Do they have lower rates of overdose? Lower rates of death?"

Patchett-Marble said the recognition for a program run by a small team in a small town with minimal resources, has been gratifying. 

"So we're kind of getting on the map a little bit, I guess. But our whole team has worked really hard to do this."