Guideline for opioid therapy and chronic noncancer pain

Abstract

hronic noncancer pain includes any painful condition that persists for at least three months and is not associated with malignant disease. n North America, clinicians commonly prescribe opioids for acute pain, palliative care (in particular, for patients with cancer) and chronic noncancer pain. Canada has the second highest rate per capita of opioid prescribing in the world when measured using defined daily doses, and the highest when defined using morphine equivalents dispensed, with more than 800 morphine equivalents per capita in 2011. ubstantial risks accompany the use of opioids in chronic noncancer pain. In Ontario, admissions to publicly funded treatment programs for opioid-related problems doubled from 2004 to 2013, from 8799 to 18 232. 8,9 Among Ontarians receiving social assistance, 1 of every 550 patients started on chronic opioid therapy died of opioid-related causes at a median of 2.6 years from the first opioid prescription, while 1 in 32 of those receiving 200 mg morphine equivalents daily (MED) or more died of opioid-related causes. 10 An estimated 2000 Canadians died from opioid-related poisonings in 2015 11 and initial numbers for 2016 are higher, with most deaths attributed to fentanyl. n 2010, the National Opioid Use Guideline Group offered recommendations for safe and effective use of opioids. Many of the recommendations were nonspecific and almost all supported the prescribing of opioids; the guideline provided few suggestions about when not to prescribe. 11 A time-series analysis in Ontario, Canada, from 2003 to 2014, found a slight decline in overall opioid prescribing, but no change in rates of fatal opioid overdose and increases in both high-dose opioid prescribing and opioid-related hospital visits. Moreover, 40% of recipients of long-acting opioids received > 200 mg MED, and 20% received > 400 mg MED. It adheres to standards for trustworthy guidelines 15 and aspires to promote evidence-based prescribing of opioids for chronic noncancer pain.