opioids

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