The HARMS Program is a clinic-wide system built to support routine urine drug testing (UDT) as a method of monitoring safety in patients prescribed opioids for chronic non-cancer pain. First implemented in clinical practice in 2014-15, it has went on to receive numerous awards at the provincial and national levels for innovation and scalability. HARMS is based on the principle that UDT results can be seen as indicators of risk, and may adjust the risk/benefit balance of these medications and change if and how these are prescribed and further monitored. UDT may help identify risks sooner, including addiction to opioids, and adjust management to meet the needs of the patient. UDT is certainly not the only marker of risk, and must be used as part of a clinical Gestalt to guide patient discussion, however it is an important enough component that it is recommended by numerous national and international guidelines. Unfortunately, UDT is not commonly done in practice due to numerous logistical barriers. HARMS was built in a resource-limited setting to address these barriers in an efficient way. This includes improving efficiency, adherence to best practices, and accuracy of interpretation through the core program features of: automation (START-IT Tool), delegation to non-medical staff members (protocols), and simple and versatile clinical algorithms to guide action (HARMS Risk Ladder). It has been refined and studied and early results suggest it is effective at identifying patients who are at risk, and changing management (including starting treatment for addiction). Clinical expansion has begun, and further research including a pending feasibility study for further expansion and evaluation.
The complete HARMS manual is available through the links to the right, or as different PDFs according to your needs:
- HARMS Manual - Web.pdf (20MB)
- HARMS Manual - Print.pdf (69MB)
- HARMS Manual - Professional Print.pdf (70MB)
Check out the video below for a brief explanation of the program.