College Welcomes 2017 Canadian Guideline for Opioids for Chronic Pain

Statement from Dr. David Rouselle, President

The College of Physicians and Surgeons of Ontario welcomes the release of the new Canadian guideline for opioid therapy for chronic non-cancer pain. Prescribing opioids under the right conditions is critical for good patient care.

Opioids should not be the first line of therapy in chronic pain and we are pleased with the guideline’s emphasis on the consideration of other modalities. In fact, 7 of the 10 recommendations in the guideline focus on harm reduction, such as optimizing other non-opioid therapies and significantly restricting the daily limit of opioids to less than 90 mg MED.

Clinical evidence tells us that high doses of opioids over long periods of may worsen patients’ symptoms and can sometimes lead to addiction. We have all been confronted with the devastating consequences in communities everywhere by the alarming rates of addiction and overdose. A new approach is essential.

The College has identified and committed to specific actions within our own area of responsibility of medical regulation and our work in this area will be informed by this new guideline, as well as by our continued work with a broad range of partners. Long-term success at addressing this crisis will continue to require the coordinated action of many and we are dedicated to continuing this work.

In addition to ensuring that physicians have the information they need to prescribe safely, we are actively addressing unsafe prescribing practices; this regulatory focus has been made possible by our collaboration with the Ministry of Health and Long Term Care. The Ministry’s Narcotic Monitoring System (NMS) was developed to identify drug utilization patterns and trends and to detect unusual prescribing activities. Last year, information was provided to us from the NMS. When we receive this information, it is carefully considered to determine if further action needs to be taken to better understand the clinical context for any prescribing and ultimately, to work with physicians to change practices where needed.

We continue to believe the prescribing of opioids is an important part of clinical practice, with some patients achieving improvement in pain and function. But it also presents risks. With the introduction of this guideline, physicians may re-evaluate how they prescribe opioids. If relevant, particular attention needs to be paid to the guidelines’ recommendation about tapering. If a dose is not reduced gradually, it may cause increased pain, decreased function or opioid withdrawal which can be dangerous. Sudden cessation is never acceptable.

The guideline is an important part of a long-term strategy to deal with an opioid crisis that has developed over many years. We are committed to patient safety and we welcome this guideline as an important step in ensuring patients have access to all treatment modalities, including the safe and appropriate use of opioids.