A small town clinic in Marathon, ON, has taken big steps towards improving the procedure for opioid prescriptions with the implementation of the HARMS system. This small town clinic implemented the HARMS system (High-yield Approach to Risk Mitigation and Safety), led by Dr. Ryan Patchett-Marble which has required those with chronic pain who are using opioids for pain management to take urine drug tests.

“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.”

HARMS System

The urine drug testing system is used to monitor whether the patient is at risk for addiction, if there are any other concerning drugs within the patients system, for example, this is something that would be assessed. Dr. Patchett-Marble said that initially there was some concern from the patients that the drug testing would illicit disciplinary results but as the programme continued it became clear to them this was not the case.

The Marathon Family Health Team implemented the system with a low-risk group of patients in 2016, who were followed for a 12-month period using the urine drug screening. In following the patients it was found that one in five of the patients had a urine test result which directly affected the pain management system they were on. The information from the urine drug test results specifically resulted in the doctor managing the case to begin addiction treatment for the patient and slowly taking them off the opioid medication and/or taking other measures to ensure their safety.

“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 Dr. Patchett-Marble. “So we were quite surprised.”

Bright Lights Award

The forward thinking programme has been noticed and was awarded the Bright Lights Award from the Association of Family Health Teams of Ontario. The Bright Lights Award is bestowed to scalable pilot programmes, meaning there is great opportunity for expansion.

Dr. Patchett-Marble has plans to continue studying the programme to fully evaluate the consequences it has on those who are on an opioid management system.

“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?”

The next step is to expand to different clinics to implement the programme and continue to study its impact.