ISMP develops opioid prescribing messages for community physicians photo: istockphoto. com
I n the Fall of 2015, the Institute for Safe Medication Practices( ISMP) Canada brought together a panel of opioid experts from across the country to identify prescribing and management practices likely to result in better opioid prescribing in the community, especially for treatment of chronic noncancer pain. The panel identified a number of themes on opioid prescribing and management, which were further refined into key opioid prescribing messages.
Selection of Patients for Opioid Therapy
Do not prescribe potent opioids for patients with minor pain. Potent opioids( e. g., morphine, oxycodone, hydromorphone) are not needed for treatment of minor pain( e. g., pain resulting from musculoskeletal injuries, minor surgery, or dental work), and their use in this context can delay a patient’ s return to work. These drugs are suitable for pain associated with major trauma( e. g., fractures, major surgery), but should not be prescribed for longer than the expected recovery time( usually less than 1-2 weeks). Emergency, urgent care, and walk-in clinic physicians should prescribe quantities that will last only a few days, until patients can be seen by their regular physician.
Reserve opioids for patients with severe, chronic non-cancer pain that impairs daily function. Opioids should be considered only after adequate trials of all non-opioid treatments that are appropriate for the underlying condition. Do not prescribe opioids for fibromyalgia, headache, or low back pain. There is no compelling evidence of effectiveness in these situations, the pain relief will be minimal, and any benefits are typically outweighed by side effects and risk of harm.
Issue 4, 2016 Dialogue 27