Dialogue Volume 13 Issue 2 2017 - Page 24

National opioid guideline puts emphasis on harm reduction The new Canadian guideline for opioid therapy for chronic non-cancer pain urges doctors to take a much more conservative approach to the prescribing of opioids and, broaden the scope of the situations where they do not prescribe opioids at all. Seven of the 10 recommendations in the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain focus on harm reduction, and seek to minimize harm for a range of patients with chronic pain, including people with current or past substance use disorders, other psychiatric disorders, and those who suffer from persistent pain despite opioid therapy. Most significantly, two of the recommendations with the strongest evidence recommend that doctors instead optimize other non-opioid therapies and significantly restrict the daily limit of opioids to less than 90 mg morphine equivalents daily (MED). While this dose recommendation is in line with the US Centers for Disease Control’s Guideline for opioid prescribing and other recently released guidance, it is a marked departure from the 2010 Canadian guideline, which suggested a “watchful dose” of 200 mg MED – a figure criticized by many in the years since for being too high. The guideline’s recommendations for clinical practice were developed by an international team of clinicians, researchers and patients, led by the Michael G. DeGroote National Pain Centre at McMaster University and funded by Health Canada and the Canadian Institutes of Health Research. 1 Dr. David Rouselle, College President, said he welcomed the new guideline. “Prescribing opioids under the right conditions is critical 1 We understand the process is being reviewed. We stand by our support of the content and if there are ultimately any changes, we will reflect those accordingly. photo: istockphoto.com 24 Dialogue Issue 2, 2017