The Task Force is comprised of a variety of family physicians working in high risk communities, chronic pain management, palliative care, comprehensive family practice and emergency rooms. It is the vision of the Task Force to advocate and develop strategies for minor adjustments in provision of services to drastic systemic changes that will support better and more comprehensive care for their patients and, ultimately, reverse the trajectory of the opioid crisis.
The Opioid Recommendations document comments on eight areas that can influence the care of patients with chronic pain, on opioid treatment, with opioid dependency, or opioid use disorder. On each page, there are five patient profiles representing an increase in risk, complexity, and level of care needed. We ask that you please consider the following recommendations based on evidence, experience, and dedication of family physicians who serve patients in this realm.
The CRISM national network initiated the development of the CRISM National Guideline for the Clinical Management of Opioid Use Disorder in 2017. The guideline represents the opinion of the National Guidelines Review Committee following careful consideration of available scientific evidence and external expert peer review, and articulates the full-range of therapeutic options for the optimal treatment of adults and youth with varying presentations of opioid use disorder. With the release of the guideline, we aim to contribute to the development of a comprehensive and sustainable strategy for addressing opioid use disorder.
CRISM is the Canadian Research Initiative in Substance Misuse. Funded by the Canadian Institutes of Health Research (CIHR), CRISM is a national network of researchers, service providers, policy makers and people with lived experience. CRISM ’s overall objective is to translate evidence-based interventions for substance misuse into clinical practice, community-based prevention, harm reduction, and health system changes. Our intent is to support the creation of more effective, personal, and adoptable intervention programs and services. The National CRISM website may be found at: www.crism.ca
CRISM Prairie Node
Alberta, Saskatchewan, and Manitoba have excellent researchers investigating substance misuse/addiction interventions (including prevention, harm reduction and specialty-based addiction treatment) delivered in the clinic, the community, and in academic research settings. Each Province funds treatment and prevention of substance use/addiction and has developed strategic plans through their respective Ministries of Health and Regional Health Authorities.
Primary care management of opioid use disorders Abstinence, methadone, or buprenorphine-naloxone?
Anita Srivastava, Meldon Kahan and Maya Nader
Canadian Family Physician March 2017, 63 (3) 200-205;
Objective To advise physicians on which treatment options to recommend for specific patient populations: abstinence-based treatment, buprenorphine-naloxone maintenance, or methadone maintenance.
Sources of information
PubMed was searched and literature was reviewed on the effectiveness, safety, and side effect profiles of abstinence-based treatment, buprenorphine-naloxone treatment, and methadone treatment. Both observational and interventional studies were included.
Both methadone and buprenorphine-naloxone are substantially more effective than abstinence-based treatment. Methadone has higher treatment retention rates than buprenorphine-naloxone does, while buprenorphine-naloxone has a lower risk of overdose. For all patient groups, physicians should recommend methadone or buprenorphine-naloxone treatment over abstinence-based treatment (level I evidence). Methadone is preferred over buprenorphine-naloxone for patients at higher risk of treatment dropout, such as injection opioid users (level I evidence). Youth and pregnant women who inject opioids should also receive methadone first (level III evidence). If buprenorphine-naloxone is prescribed first, the patient should be promptly switched to methadone if withdrawal symptoms, cravings, or opioid use persist despite an optimal buprenorphine-naloxone dose (level II evidence). Buprenorphine-naloxone is recommended for socially stable prescription oral opioid users, particularly if their work or … (read full article)
(Ottawa – March 1, 2018) – Choosing Wisely Canada is launching a new campaign today to raise awareness around the importance of clinician-patient conversations to reduce harms associated with opioid prescribing. The Opioid Wisely campaign is supported by over 30 organizations representing doctors, dentists, pharmacists, nurse practitioners, other health professionals, as well as patients and their families.
Central to the campaign is a set of 14 specialty-specific recommendations for when it is unsafe to
prescribe opioids. For example, the College of Family Physicians of Canada says that patients should not continue on opioids beyond the immediate period after surgery. This period is typically three days or less, and rarely more than seven days.
- Read the full release of Opioid Wisely
- Read Recommendations for Family Medicine
- Find All 14 Specialty-specific Recommendations
Help your patients be partners in their own safe care. Share these new opioid safety fact sheets with patients to help them learn about side-effects and risks, how to take the medicine safely and when to talk to you about their treatment.
Developed jointly by the Alberta College of Pharmacists, Alberta Health Services, Alberta Medical Association, College & Association of Registered Nurses of Alberta and College of Physicians & Surgeons of Alberta.
- As the voice of Canada’s doctors, the CMA remains concerned about the potential harms of opioids, including dependence, overdose and death. While opioids continue to play an important therapeutic role for legitimate purposes, the prescribing of opioids must be done in a manner that is based on evidence, and includes careful assessment and monitoring.
- The CMA has been partnering with other key national organizations on the Pan-Canadian Collaborative on Education for Improved Opioid Prescribing. Together, our aim is to assess and gather evidence-based educational programming for health care professionals and develop proposals to help address gaps in knowledge for the management of pain.
Opioid Management Resources
- The College of Family Physicians of Canada (CFPC), as part of the Pan-Canadian Collaborative on Education for Improved Opioid Prescribing, and in response to Health Canada’s 2016 Joint Statement of Action to Address the Opioid Crisis, is partnering to provide educational resources for opioid prescribers. The Collaborative aims to address the harms associated with prescription opioids—including addiction, overdose, and death—while ensuring Canadians have timely and appropriate access to optimal treatments for acute and chronic pain.
- The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, developed by the Michael G. DeGroote National Pain Centre at McMaster University, will assist health care providers in making practice decisions about the safe and effective use of opioids for chronic non-cancer pain management.
- This guideline will assist family physicians in making practice decisions regarding the safe and effective use of opioids for chronic non-cancer pain management. It aims to keep patients safe from the potential harms of opioids while recognizing the therapeutic benefits of these medications.
Released by the CPSA: Effective as of April 1, 2017 – Opioid crisis prompts new prescribing rules for high-risk drugs
Alberta physicians will need to meet new rules for prescribing high-risk drugs like opioids, benzodiazepines, sedatives and stimulants starting April 1, 2017.
Approved today by the CPSA Council after extensive consultation with physicians, patients and stakeholder organizations, the new Prescribing: Drugs with Potential for Misuse or Diversion standard of practice puts more checks and balances in place to improve prescribing and enhance patient safety.
Being cautious in initiating patients on these drugs, making sure the patient understands the significant risks of the medication, checking the patient’s medication history before writing the prescription and being able to justify prescribing decisions with documented patient assessments are some of the general requirements.
There are also specific safeguards for prescribing long-term opioid treatment for patients with chronic pain.
The standard does not prevent physicians from prescribing opioids when appropriate, or continuing opioid treatment for patients who are dependent.
- The objective of this guideline is to provide clinical recommendations for the initiation, maintenance and discontinuation of buprenorphine/naloxone
maintenance treatment in the ambulatory treatment of adults and adolescents with opioid dependence in Ontario.
- The guideline intends to contribute to education of practitioners regarding opioid prescribing, improved patient access to treatment for opioid dependence, and safe prescribing and dispensing of buprenorphine/naloxone.
- This evidence-based clinical practice guideline was developed by a multidisciplinary committee, and included specialists in the field of addiction medicine, family medicine and pharmacy.
- A systematic review of the literature formed the evidence base for this guideline, and recommendations were assigned levels of evidence and grades of recommendations based on those developed by the Canadian Task Force on Preventive Health Care.
National Pain Centre – McMaster – Safe and Effective Use of Opioids for Non-Cancer Pain – Practice Toolkit
This toolkit includes:
- A collection of e-practice tools for use before prescribing, to select the right opioid and titrate effectively and to monitor for safety and effectiveness and for tapering.
- There are also patient handouts, agreements, risk assessments
- The Opioid Manager which is a point of care tool for providers prescribing opioids for chronic non-cancer pain and is based on the Canadian Opioid Guideline
The 2010 Full Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain
Opioid medications are used to treat pain. Opioids are also known as narcotics. In recent years more and more Canadians are using opioids, and research indicates that we are now the world’s second largest consumer of opioids. Along with this increased use of opioids there has also been a corresponding and alarming increase in the harm from opioids.
ISMP Canada is the leading medication safety organization in Canada. Through our ongoing analysis of medication safety incidents, we have found that opioids are frequently associated with harmful consequences-including death-when they are prescribed, used or administered incorrectly or in error.
In response, we have created an Opioid Stewardship Program to help people to become better informed about opioids and to help reduce and prevent harm. This web page has been developed to provide members of the public and health care practitioners with useful and accurate information regarding opioids.
Sometimes the best of intentions lead to devastating consequences. Canada and the U.S. are the two highest consumers of prescription opioids even though we don’t have good evidence that they are effective for chronic pain. Since there are many di¬fferent opioids used for the same purpose, we use morphine equivalence to compare how strong they are.
The BC Centre on Substance Use (BCCSU) is a provincially networked organization with a mandate to develop, help implement, and evaluate evidence-based approaches to substance use and addiction.
Until June 5, 2017, this guideline is provided for educational purposes. For clinicians wishing to prescribe buprenorphine/naloxone and/or methadone please refer to the College of Physicians and Surgeons of BC’s “Methadone and Buprenorphine: Clinical Practice Guideline for Opioid Use Disorder.”
After June 5, 2017, this guideline will become the provincial guideline for the province of British Columbia