ONTARIO COLLEGE OF FAMILY PHYSICIANS
340 Richmond St. West
Toronto, ON M5V 1X2
Phone: 416-857-9646 ◊ Fax: 416-867-9990
Pain and Addictions Primer for Family Physicians
Friday March 21, 2014
8:00am– 5:00pm
LOCATION: TBD
Pembroke, ON
Patients presenting with the complications of opioid addiction and chronic pain are difficult to manage in the context of
a family practice. This 1 day course is being offered to family physicians with a comprehensive family medicine
practice who care for pain/addictions patients or those physicians with focused practices in pain and/or addictions
care.
Session Date:
Friday March 21, 2014 (8:00am-5:00pm)
Breakfast and Registration- 8:00am-8:30am
Workshop Commencement- 8:30am-5:00pm
Speakers: Drs. Alan Kaplan & Sean Moore
What is being offered?
 1 day course of case-based scenarios on addictions and chronic pain
 8 cases covering all major systems in addictions and pain management
This program meets the accreditation criteria of The College of Family Physicians of Canada and has been accredited
for 6.5 Mainpro-C credits.
Registration/Contact Information:
Prefix: Dr. First Name: _____________________ Last Name: _____________________
Address: ________________________________________________ City: ____________
Province: ON Postal Code: _____________ Email Address: ________________________
Telephone: _________________________
CFPC Member:
MMAP Member:
 Yes
 Yes
 No
 No
Payment Information (check one):
Fax: ______________________________
CFPC Number: _________________________
If Yes: Group: ___________________________
 Visa
 MasterCard
Card Number: _________________________________
Expiry: ______________
Amount Authorized: $____________________________
Registration Fee: $450.00 (HST Incl.)
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On-site registration will NOT be available
The OCFP reserves the right to cancel sessions due to unforeseen circumstances or insufficient advance registration. In the event of a
cancellation made by the OCFP, a full refund will be given to the registrants. However, the OCFP cannot accept responsibility for outof-pocket expenses due to cancellation of a session. Cancellations made by March 7, 2014 will be refunded, less a 25% administration
fee.
For more information or if you have questions, please contact Vincenza Piccolo at vincenza@cfpc.ca or at
416 867 9646 x 32
Please complete and submit page 2-5 by fax at 416 867 9990
To better assess your needs and experience, please use the following link to access our questionnaire. If you prefer to
provide us with your answers in a written format, please complete the following forms and fax documents to 416867-9990.
Pre-Course Assessment Questionnaire: https://www.surveymonkey.com/s/7BD6ZQF
ALL following questions must be completed (incomplete forms will not be processed).
Please note that any information you provide will be kept confidential and will only be reported in grouped form:
1. Current Status:
Family Physician
Focused Practice Physician


TYPE OF PRACTICE




a.
b.
c.
d.
Full-Time
Solo
Office
Urban




Part-Time
Group
Hospital
Suburban
 Both
 Both
 Rural
2. How did you hear about the Pain and Addictions Primer for Family Physicians?
_____________________________________________________________
3. How many years of experience do you have in managing pain/addictions patients?
___________
4. How would you rate your comfort level in prescribing opioids?
Poor
Fair
Good
Very Good
Excellent
1
2
3
4
5
5. How would you rate your current level of confidence in your ability to manage chronic pain?
Not Confident Slightly Confident Fairly Confident Quite Confident Very Confident
1
2
3
4
5
6. In the past six months, how many patients have you prescribed opioids for chronic non-cancer pain? Please
circle your option
0
Page 2 of 5
1-5
6-10
11-15
16-20
21 or more
7. In the past six months, for how many patients on long-term opioids have you ordered a urine drug screen?
Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
8. In the past six months, for how many patients on long-term opioids have you decreased (tapered) the opioid
dose? Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
9. In the past six months, for how many patients on long-term opioids have you increased the frequency of
dispensing (eg from once every month to once every week)? Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
10. In the past six months, for how many patients on long-term opioids have you referred the patient to an
addiction program (methadone or buprenorphine?) Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
11. Based on the course outline listed below, do you see this program making a difference in your practice?
 Yes
 No
12. How do you best see yourself integrating this new knowledge into your practice?
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13. Please specify the top 3 areas of concern you hope this course will address:
1) ________________________________________________________________
2) ________________________________________________________________
3) ________________________________________________________________
14. How interested are you in learning more about each of the topics listed below?
Not at all
interested
A little
interested
Somewhat
interested
Quite
Extremely
interested interested
Urine drug testing
Who should receive opioids for CNCP
How do you titrate the opioid dose
Preventing overdose
Tapering the benzodiazepine dose
Tapering the opioid dose
Screening for opioid addiction risk
When to refer for (methadone,
buprenorphine treatment
Buprenorphine prescribing for family
physicians
Sleep issues and pain
Opioids for special populations
(elderly, psychiatric patients etc)
Non-opioid treatments for pain
Comprehensive treatment of pain
Aberrant drug-related behaviours
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15) Please provide a brief outline of a real case or problem related to opioid prescribing you have faced in your
practice that you would like to have discussed during the course:
16) Breakfast and lunch will be provided. Do you have any life threatening or serious food allergies we should be
aware of?
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