New Guidelines Set to Address Canadian Opioid Issues

Kevin Kunzmann

The guidelines call for a crackdown on chronic non-cancer pain prescriptions.

In response to globally high rates of opioid use, Canadian physicians have been given new guidelines on chronic non-cancer pain prescription.

The guidelines — “Guideline for opioid therapy and chronic noncancer pain” published in the Canadian Medical Association Journal on May 8 — were compiled by an international team of clinicians, researchers and involved patients and led by the Michael G. DeGroote National Pain Centre at McMaster University.

The study followed up a national guideline first made available in 2010.

The previous set of standards had a limited impact on the national rate of opioid use, McMaster’s Michael G. DeGroote School of Medicine associate professor of anesthesia and principal guideline development investigator Jason Busse (pictured) said.

Though the new guidelines are not self-implementing, Busse said Canadian physicians should learn it and apply it in practice.

“We recognize implementation is a provincial responsibility, but we need dedicated funding for a national strategy to effectively ensure the guideline is used, and that we measure its impact,” Busse said.

Recommendations in the new guidelines include considering non-drug and non-opioid pharmacotherapy over a trial of opioids for non-cancer chronic pain, and only prescribing a trial of opioids to patients who have first not responded to non-opioid treatment and have no history of substance use disorder or other psychiatric disorders.

The guidelines also suggest patients beginning opioid therapy be restricted to daily doses under 50mg morphine equivalents. They strongly recommend daily doses be held to under 90 mg daily — while the 2010 guidelines suggested a maximum of 200 mg morphine equivalents daily.

Physicians are also advised to taper opioid administration to its lowest effective dose for patients currently using 90 mg or more daily.

The guidelines do not include recommendations for opioid use for acute pain, nor for cancer-related pain treatment or palliative care. It also does not make any recommendations for opioid use disorder or addiction.

These regulation recommendations address what Busse called a current opioid epidemic in Canada. Its residents are currently the second highest opioid users per capita in the world, and there has been a significant increase in opioid prescription, opioid-related hospital visits, and deaths.

According to the study, admissions to publicly funded treatment programs in Ontario for opioid-related problems doubled from 2004 to 2013 — from 8,799 to 18,232.

An estimated 15 to 19% of Canadians live with chronic non-cancer pain — or, pain that lasts longer than 3 months and interferes with daily activities.

Busse considers a change in treatment necessary.

“Opioids are not first line therapy for chronic non-cancer pain,” Busse said. “There are important risks associated with opioids, such as unintentional overdose, and these risks increase with higher doses.”

The new guidelines were developed over the past 2 years by a 4-member steering committee, a 15-member guideline panel of clinicians, research methodologists and patients, a 13-member multi-disciplinary advisory group of experts in pain treatment and opioid use, and a 16-person patient advisory committee.

The guideline was finalized with consideration from 500-plus comments of individuals and associations that responded to draft recommendation requests released this January.

The “Guideline for opioid therapy and chronic noncancer pain,” was Canadian Medical Association Journal.

The guidelines were detailed in a press release.

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