Canadian guideline now being revised to reflect current evidence
opioids
Increase in deaths prompts release of U. S opioid guidance
Canadian guideline now being revised to reflect current evidence
The College expects physicians to use their clinical judgment when treating chronic non-malignant pain and be familiar with relevant and current practice guidelines, as well as our Prescribing Drugs policy.
Recently, the Centers for Disease Control and Prevention( CDC) released a guideline that although similar to the current Canadian guideline in a number of respects, does take a more conservative stance on dosing for chronic non-cancer pain.
The CDC recommendations urge clinicians in the U. S to carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents( MME)/ day, and states that clinicians should avoid increasing dosage to ≥90 MME / day. In comparison, the 2010 Canadian guideline states that:“ Chronic non-cancer pain can be managed effectively in most patients with dosages at or below 200 mg / day of morphine or equivalent.” The CDC said the guideline is a response to the increasing number of deaths attributable to opioid overdoses.
The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain – which is under the stewardship of the Michael G. DeGroote Institute for Pain Research and Care( IPRC) – is currently being revised to ensure that it reflects evolving evidence and the current environment. The updated guideline is expected to be released in January 2017. Both the CDC guideline and the Canadian guideline are available as references to doctors on the College’ s website at www. cpso. on. ca.“ I think the CDC guideline make it clear that the landscape is evolving, and there is a need to be more cautious in our prescribing of opioids,” said Dr. Rocco Gerace, College Registrar. Dr. Gerace said he looks forward to seeing the new Canadian guideline, but points out that as with any clinical guideline, physician adherence is fundamental to ensuring good patient outcomes are achieved. Physicians who come before the College to answer for unsafe prescribing practices appear not to have followed any accepted guideline, he said. The Narcotic Monitoring System, which is operated by the Ministry
Some of the common issues that the CPSO sees include:
• Starting opioids with no clear diagnosis;
• Starting patients on highdoses of opioids without employing a slower, more cautious approach to the initiation of therapy;
• Not considering drug interactions; particularly between opioids and benzodiazepines; and
• Not following recommended practices when dealing with aberrant drug related behaviour
“ As with any clinical guideline, physician adherence is fundamental to ensuring good patient outcomes are achieved.”
Issue 2, 2016 Dialogue 21