Dialogue Volume 12 Issue 4 2016 | Page 27

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 .
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