“We are committed to patient safety and we welcome this guideline
as an important step in ensuring patients have access to all treatment
modalities” – Dr. David Rouselle, College President
for good patient care, but 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,” he said.
“Clinical evidence tells us that high doses
of opioids over long periods may worsen
patients’ symptoms and can sometimes lead
to addiction. We have all been confronted by
the alarming rates of addiction and overdose
in communities everywhere. A new approach
is essential,” he added.
An estimated 2,000 Canadians died from
opioid-related poisonings in 2015 and
preliminary numbers for 2016 are expected
to be higher, with most deaths attributed to
fentanyl.
With the introduction of this guideline,
physicians may re-evaluate how they pre-
scribe opioids. If this is the case, particular
attention needs to be paid to the guideline’s
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 wel-
come this guideline as an important step in
ensuring patients have access to all treatment
modalities, including the safe and appropriate
use of opioids,” said Dr. Rouselle.
The guideline also includes Best Practice
Statements and expert guidance on issues
such as co-prescribing with opioids, opioid-
induced sleep apnea, and immediate versus
controlled release opioids. A section of the
guideline is devoted to risk mitigation and
references such issues as treatment agree-
ments, the fentanyl patch exchange and urine
drug screening.
While absolute compliance with clinical
guidelines is neither achievable nor desirable,
given the need to address specific patient
situations, physicians must be aware of the
guidelines and be able to explain any diver-
sion from them.
Issue 2, 2017 Dialogue
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