Dialogue Volume 13 Issue 2 2017 - Page 25

“We are committed to patient safety and we welcome this guideline as an important step in ensuring patients have access to all treatment modalities” – Dr. David Rouselle, College President for good patient care, but opioids should not be the first line of therapy in chronic pain and we are pleased with the guideline’s emphasis on the consideration of other modalities,” he said. “Clinical evidence tells us that high doses of opioids over long periods may worsen patients’ symptoms and can sometimes lead to addiction. We have all been confronted by the alarming rates of addiction and overdose in communities everywhere. A new approach is essential,” he added. An estimated 2,000 Canadians died from opioid-related poisonings in 2015 and preliminary numbers for 2016 are expected to be higher, with most deaths attributed to fentanyl. With the introduction of this guideline, physicians may re-evaluate how they pre- scribe opioids. If this is the case, particular attention needs to be paid to the guideline’s recommendation about tapering. If a dose is not reduced gradually, it may cause increased pain, decreased function or opioid withdrawal which can be dangerous. Sudden cessation is never acceptable. “The guideline is an important part of a long-term strategy to deal with an opioid crisis that has developed over many years. We are committed to patient safety and we wel- come this guideline as an important step in ensuring patients have access to all treatment modalities, including the safe and appropriate use of opioids,” said Dr. Rouselle. The guideline also includes Best Practice Statements and expert guidance on issues such as co-prescribing with opioids, opioid- induced sleep apnea, and immediate versus controlled release opioids. A section of the guideline is devoted to risk mitigation and references such issues as treatment agree- ments, the fentanyl patch exchange and urine drug screening. While absolute compliance with clinical guidelines is neither achievable nor desirable, given the need to address specific patient situations, physicians must be aware of the guidelines and be able to explain any diver- sion from them. Issue 2, 2017 Dialogue 25