Guidelines

Opioid prescribing guidelines

The potential for dependency and negative health consequences continues to be an important consideration in primary care setting. This section provides links to relevant Canadian Guidelines for opioids in the context of chronic and non-cancer pain along with easy to use tools that provide quick access to key information. You will also find a link to the Canadian Agency for Drugs and Technologies in Health’s (CADTH) Opioid Evidence Bundle.

Introduced as a wait-time reduction strategy, eConsult is also now available and provides a secure online platform for primary care providers (family physicians and nurse practitioners) to access patient specific, non-urgent specialist advice. Access to specialist advice can increase the capacity of primary care providers to manage patient care in the community. eConsult may also reduce the burden on specialist wait lists by avoiding unnecessary face-to-face specialist referrals, where appropriate. Two specialties available through eConsult are Opioid Addiction Management and Chronic Pain Management.

ResourceBrief description
2017 Canadian Guidelines for Opioids for chronic and Non-Cancer PainPublished by McMaster University, this document details guidelines on the use of opioids to manage chronic non-cancer pain for adults. The guidelines are intended to increase patient safety and reduce risks of unintended harm while reducing opioid prescribing levels. They also cover strategies for overdose prevention, and resources to help guide tapering and assessing of opioid use disorder.   
One-page summary of the 2017 Canadian Opioid Prescribing GuidelineMcMaster National Pain Center provides a one-page summary of the 2017 Canadian Opioid Prescribing Guideline recommendations on dosing a nd other recommendations for pain management.      
Practical App for the 2017 Canadian Opioid Prescribing Guideline  This easy to navigate App provides easy access to the evidence underpinning the recommendations in the 2017 Canadian Opioid Prescribing Guideline document.            
eConsult  Connected Health is conceptual model for healthcare which encompasses terms such as wireless, digital, electronic, mobile, and tele-health.  Connected Health includes eConsult which has been available since May 2018 and allows primary care providers to access specialist advice for non-urgent, patient specific questions through the provincial Electronic Health Record’s secure platform.  
CADTH Opioid Evidence BundleHere you’ll find CADTH’s collection of its best evidence on opioids, divided under the topics of Pain Treatment; Misuse, Overdose, and Harms; Opioid Use Disorder (Addiction); and Alternatives to Opioids. Under “Tools and Resources,” you’ll find tools you can use to translate research into action as well as other, non-CADTH information from Choosing Wisely Canada and the Canadian Centre on Substance Use and Addiction.      

Dosing

This section provides links to helpful tools and resources on the topic of opioid dosing for safe and effective use of opioids in primary care settings. Along with opioids prescribing guidelines for non-cancer pain management, these tools can be helpful in establishing dosing schedules for patients.

ResourceBrief description
One-page summary of the 2017 Canadian Opioid Prescribing Guideline SummaryProvides a one-page summary of the 2017 Canadian Opioid Prescribing Guideline recommendations on dosing and other recommendations for pain management.
Michael G. DeGroote National Pain Center “Opioid Manager”  Provides access to download the point-of-care “Opioid Manager” tool
Tool: Opioid Conversion and Brand Availability in Canada – Oral opioid analgesic conversion tableThe Canadian guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain from McMaster’s University offers quick access to this opioid conversion tool.  
Morphine Equivalence Guide – Navigating Opioids for Chronic PainGuidance for primary care providers to help compare how strong different opioids are for the same purpose to reduce the risks of harm. As the number of morphine equivalents per day increase, the harms associated with opioid therapy also increases. This infographic can help determine if the dose being prescribed is helpful or potentially harmful.  
Tool: Knowing when to initiate or continue opioids for chronic painThe College of Physicians and Surgeons of New Brunswick provides guidance for determining when to initiate or continue opioids for chronic pain