Canadian Opioid Guideline
General FAQs
Common
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- It is an evidence-based guideline with 24 recommendations outlining how to use opioids to treat patients with chronic non-cancer pain.
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- Existing treatment information and guidelines were found to be outdated or too focused on specific health problems other than CNCP.
- Canadian physicians asked for clear, evidence-based guidance to safely manage treatment for CNCP patients, using opioids.
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- To improve the safety and care of chronic non-cancer pain patients being treated with opioids.
- To safely manage potential side effects (including addiction) and the risk of opioid misuse; there is growing concern that opioid misuse is creating patient and public safety issues.
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- Opioids have been proven effective to reduce the intensity of pain for CNCP patients, and can be part of an effective treatment process.
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- We don’t know because opioid prescriptions are not tracked in every province.
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- Not completely. However, use of the new guideline may decrease the likelihood of misuse.
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- No. Opioid treatment for CNCP is only one of many treatments.
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- No. The guideline only applies to treatment of CNCP using opioids.
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- Several groups were involved in the research, drafting, reviewing and approval of the new guideline. These included:
- A Research team of academic experts (research librarian and associate, epidemiologist and physician-researchers) who researched and drafted the initial recommendations.
- A National Advisory Panel (NAP) consisting of 49 individuals from across Canada who reviewed the recommendations. The panel included:
- Pain specialists
- Family physicians
- Addiction experts
- Pharmacists
- Academics
- Nurses
- Patient group representatives
- The National Opioid Use Guideline Group (NOUGG) - 18 representatives from Canadian Medical Regulatory Authorities and the Federal Medical Regulatory Authorities of Canada (FMRAC) who coordinated the development and implementation of the guideline and were responsible for final approval.
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- Yes, representatives from a national patient group provided feedback as part of the National Advisory Panel (NAP).
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- It took nearly three years to research, review and approve the guideline.
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- The National Opioid Use Guideline Group (NOUGG), with input from the research team and the National Advisory Panel (NAP).
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- The guideline was released on May 3, 2010.
- Implementation will follow throughout 2010 and into 2011.
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- Primary-care physicians and specialists who manage patients with chronic non-cancer pain (CNCP).
- It may also be useful for pharmacists who dispense opioids, and nurses and dentists involved in the treatment of patients with CNCP.
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- No. Use of the guideline is voluntary.
Patient Treatment
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- Under the new guideline, modifications to a patient’s treatment may be considered, with the understanding that each patient/situation is different.
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- All physicians have an obligation to ensure patient treatment is safe and effective, regardless of whether they choose to follow the new guideline.
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- The guideline makes recommendations on what is safe and effective opioid treatment for chronic non-cancer pain (CNCP). Whether this is less or more than what a physician currently prescribes will depend on the individual patient and situation.
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- No. However, the physician should consider the most safe and effective treatment for his/her patient.
- Note: The guideline recognizes that some patients may require higher doses of opioids. For example: cases where a patient benefiting from opioid treatement for CNCP develops a tolerance to the current dose.
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- The same measures currently employed by regulatory bodies will be in effect to monitor and identify if this occurs.
- If a physician’s regulatory body doesn’t track ‘doctor shopping’ or ‘double doctoring’, it will be important for the physician to use available information regarding the patient’s prescription history and opioid use.
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- Yes, but only if the physician determines there is a risk to the patient’s safety or the physician does not feel qualified to handle treating CNCP with opioids.
- In either case, alternate methods for treating chronic non-cancer pain should be considered.
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- Most physicians are interested in providing quality care to their patients, however some may choose to defer treatment to ohters more familiar with treating CNCP.
Chronic Non-Cancer Pain (CNCP)
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- Chronic non-cancer pain (CNCP) is classified as non-malignant pain that exists for more than six months. More specifically, CNCP is:
- a symptom of many diseases including arthritis, spinal disc herniation, stroke and trauma
- most commonly caused by low-back pain
- associated with increased use of health services
- the most common cause of long-term disability.
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- Approximately 29 per cent of Canadians suffer from CNCP including:
- 38 per cent of institutionalized seniors, and 27 per cent of seniors living in households.
- Three million (10 per cent) Canadians who suffer from osteoarthritis.
- One million (three per cent) Canadians who live with neuropathic pain, including headaches and nerve pain.