National Opioid Guideline

The Canadian Guideline for Safe and Effective Use of Opioids is a national, evidence-based guideline to help primary-care physicians and specialists safely and effectively use opioids to treat patients with chronic non-cancer pain (CNCP).

The guideline is not intended to be used as a policy or standard of practice, but as a practical resource to provide Canadian physicians with the best available information, research and consensus of opinion on this topic.

Complete versions of the guideline are available in English in electronic formats from the Michael G. DeGroote National Pain Centre at McMaster University. French translation of these documents will be completed as soon as possible.

Collaborate to determine dosage for opioid alternative

Opioid Manager – New Practice Tool

A new “Switching Opioids” form has been developed to help health practitioners determine the equi-analgesic dose of alternative opioid when switching from one opioid to another. available here

A statement from the CPSO, OMA, OCP and OPA

After a fatality apparently resulting from a change in prescription from OxyContin to another opioid analgesic, physicians and pharmacists are being advised to work closely in determining the appropriate dosage for medications prescribed to replace the discontinued OxyContin.

Over the next several weeks and months, physicians and pharmacists will be facing situations that may require either a direct shift in prescribing and dispensing from OxyContin to the new, tamper-resistant OxyNEO or a more complex conversion from OxyContin to another opioid alternative. In the latter scenario, both physicians and pharmacists must be aware of the challenges associated with such conversions, say the regulatory bodies and associations of both professions.

The College of Pharmacists and the Ontario Pharmacists’ Association are encouraging their members to contact the prescribing physician for clarification of dose changes where possibly unintentional dose escalation is noted. The College of Physicians and Surgeons of Ontario and the Ontario Medical Association are urging physicians to be receptive to this contact and work closely with pharmacists in determining the equi-analgesic dose of alternative opioid therapies for chronic non-cancer pain management.

“Given the complexities of opioid prescribing and dispensing, it is critical that we work together to ensure the safety of the public,” said Dr. Bob Byrick, President of the College of Physicians and Surgeons of Ontario.

The CPSO appreciates that physicians may have a number of questions about the Ministry of Health and Long-Term Care's imminent removal of OxyContin from the Ontario Drug Benefit Formulary/Comparative Drug Index and its replacement, OxyNEO. The MOHLTC provide answers to frequently asked questions about the introduction of OxyNEO and resulting changes to the Ontario Drug Benefit Formulary. Information from the MOHLTC

Prescribing Buprenorphine (Suboxone)

Physicians should consider all available treatment options for their patients, including buprenorphine (Suboxone). Unlike methadone, there is no regulatory framework that restricts the prescribing of buprenorphine (Suboxone) to approved physicians. If physicians want to help a patient who is in need of treatment but don’t have sufficient knowledge, skill or experience to do so, the College encourages them to consider providing therapy in consultation with the Addiction Clinical Consultation Service of the Centre for Addiction and Mental Health (CAMH) at (416) 535-8501 ext. 2.

For additional resources, see the FAQ document about prescribing Buprenorphine, which has replaced the Buprenorphine Hydrochloride for the Treatment of Opioid Dependence policy. In addition, the CAMH has developed information to assist during this transition period which is available here .