2017 Canadian Guideline for Opioids
for Chronic Non-Cancer Pain
Summary of recommendations
Recommendation 1
When considering therapy for patients with chronic non-
cancer pain, optimization of non-opioid pharmacother-
apy and non-pharmacologic therapy, is recommended,
rather than a trial of opioids. (strong recommendation)
Recommendation 2
For patients with chronic non-cancer pain, without
current or past substance use disorder and without other
active psychiatric disorders, who have persistent problem-
atic pain despite optimized non-opioid therapy, adding
a trial of opioids is suggested, rather than continued
therapy without opioids. (weak recommendation)
• A trial of opioids means initiation, titration and moni-
toring of response, with discontinuation of opioids if im-
portant improvement in pain or function is not achieved.
The studies that identified substance use disorder as a risk
factor for adverse outcomes characterized the conditions
as alcohol abuse and dependence, and narcotic abuse
and dependence, and sometimes referred to International
Classification of Diseases, 9th revision (ICD-9) diagno-
ses. The mental illnesses identified in studies as risk factors
for adverse outcomes were generally anxiety and depres-
sion, including ICD-9 definitions, as well as “psychiatric
diagnosis,” “mood disorder” and post-traumatic stress
disorder.
Recommendation 3
For patients with chronic non-cancer pain with an active
substance use disorder, the use of opioids is not recom-
mended. (strong recommendation)
• C
linicians should facilitate treatment of the underlying
substance use disorders, if not yet addressed. The studies
that identified substance use disorder as a risk factor for
adverse outcomes characterized the conditions as alcohol
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Dialogue Issue 2, 2017
abuse and dependence, narcotic abuse and dependence,
and sometimes referred to ICD-9 diagnoses.
Recommendation 4
For patients with chronic non-cancer pain with an active
psychiatric disorder whose non-opioid therapy has been
optimized, and who have persistent problematic pain,
it is suggested that the psychiatric disorder be stabilized
before a trial of opioids is considered.
(weak recommendation)
Recommendation 5
For patients with chronic non-cancer pain with a history
of substance use disorder, whose non-opioid therapy has
been optimized, and who have persistent problematic
pain, it i