Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New Canadian clinical guideline for physicians tapers down use of opioids

08.05.2017

A new guideline for clinical care that focuses on harm reduction

Canadian physicians are being advised to reduce their prescribing of opioid medication to patients with chronic non-cancer pain in a new guideline for clinical care that focuses on harm reduction.


This is an image of opioids.

Credit: McMaster University

The guideline was developed in response to concerns that Canadians are the second highest users per capita of opioids in the world, while the rates of opioid prescribing and opioid-related hospital visits and deaths have been increasing rapidly.

The guideline's recommendations for clinical practice have been 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. The guideline was published by the Canadian Medical Association Journal (CMAJ) today at http://bit.ly/2pESNK4.

The guideline incorporates medical evidence published since the previous national opioid use guideline was made available in 2010. They are recommendations for physicians, but are not regulatory requirements.

An estimated 15% to 19% of Canadians live with chronic non-cancer pain, which is pain lasting more than three months and interfering with daily activities.

The guideline does not look at opioid use for acute pain, nor for patients with pain due to cancer or in palliative care, or those under treatment for opioid use disorder or opioid addiction.

The recommendations include:

  • Non-drug and non-opioid pharmacotherapy be considered first and optimized for patients with chronic non-cancer pain rather than a trial of opioids.
  • A trial of opioids for patients who have not responded to non-opioid treatment and who do not have a current or past substance use disorder or other current psychiatric disorder.
  • The suggestion that the dose be restricted to under 50mg morphine equivalents a day for patients starting opioid therapy, and the strong recommendation that the daily dose be under 90 mg a day. The previous guideline suggested a watchful dose of 200mg morphine equivalents a day.
  • A trial tapering of opioids to the lowest effective dose, potentially to none, for patients currently using 90 mg morphine equivalents a day or more, recognizing there are some patients who may need tapering paused or abandoned.

The guideline and related material is available at http://bit.ly/2quyj4Z. This also includes an app available to help physicians and patients work through shared decision-making on the topic. This is available at http://bit.ly/2pC9947.

"Opioids are not first line therapy for chronic non-cancer pain. There are important risks associated with opioids, such as unintentional overdose, and these risks increase with higher doses," said Jason Busse, principal investigator for the guideline development, an associate professor of anesthesia of McMaster's Michael G. DeGroote School of Medicine, and researcher for the Michael G. DeGroote National Pain Centre.

"Canada is in the midst of an opioid epidemic. The guideline aspires to promote evidence-based prescribing of opioids for chronic non-cancer pain."

Also in the CMAJ today is a related commentary http://bit.ly/2oUcONO about the new Canadian guideline. Dr. Andrea Furlan of Toronto Rehabilitation Hospital and Dr. Owen Williamson of Monash University in Australia, say the updated guideline aims "to promote safer and more effective opioid prescribing to the small proportion of patients with chronic non-cancer pain who may benefit from their use, and this may well be achieved."

Busse added that Canadian physicians must now learn about the new guideline and apply its recommendations in practice, noting that recent research has shown limited impact of the guideline published in 2010.

"The guideline isn't self-implementing. We recognize implementation is a provincial responsibility, but we need dedicated funding for a national strategy to effectively ensure the guideline is used, and that we measure its impact."

The guideline's recommendations were developed over the past two years by a team that included a four-member steering committee; a 15-member guideline panel of clinicians, research methodologists and patients; a 13-member multi-disciplinary advisory group of experts in the treatment of pain and use of opioids, and a 16-person patient advisory committee.

Specific care was made to ensure the recommendations are evidence-based, guided by patients' values and preferences, and that guideline panel members who voted on the recommendations were free of important financial or intellectual conflicts of interest.

For the final guideline, consideration was given to more than 500 comments from individuals and associations who answered a call for response to the draft recommendations released in January.

###

Editors:

  • The recommendations, a backgrounder, photo and video interview are available for downloading here http://bit.ly/2quyj4Z
  • A CMAJ podcast is here http://bit.ly/2psKwII
  • McMaster provides a high-definition broadcast studio that can connect with any television broadcaster.
  • As well as principal investigator Jason Busse, members of the patient advisory committee Lynn Cooper (Ontario) and Chris Cull, (British Columbia) are available for comment.

To book an interview, please contact:

Veronica McGuire
Media Relations Co-ordinator
Faculty of Health Sciences
McMaster University
T: (905) 525-9140, ext. 22169
vmcguir@mcmaster.ca

http://www.mcmaster.ca 

Veronica McGuire | EurekAlert!

Further reports about: CMAJ chronic non-cancer pain morphine non-cancer pain

More articles from Health and Medicine:

nachricht New discoveries predict ability to forecast dementia from single molecule
12.12.2018 | UT Southwestern Medical Center

nachricht Pain: Perception and motor impulses arise in the brain independently of one another
12.12.2018 | Technische Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Lethal combination: Drug cocktail turns off the juice to cancer cells

A widely used diabetes medication combined with an antihypertensive drug specifically inhibits tumor growth – this was discovered by researchers from the University of Basel’s Biozentrum two years ago. In a follow-up study, recently published in “Cell Reports”, the scientists report that this drug cocktail induces cancer cell death by switching off their energy supply.

The widely used anti-diabetes drug metformin not only reduces blood sugar but also has an anti-cancer effect. However, the metformin dose commonly used in the...

Im Focus: New Foldable Drone Flies through Narrow Holes in Rescue Missions

A research team from the University of Zurich has developed a new drone that can retract its propeller arms in flight and make itself small to fit through narrow gaps and holes. This is particularly useful when searching for victims of natural disasters.

Inspecting a damaged building after an earthquake or during a fire is exactly the kind of job that human rescuers would like drones to do for them. A flying...

Im Focus: Topological material switched off and on for the first time

Key advance for future topological transistors

Over the last decade, there has been much excitement about the discovery, recognised by the Nobel Prize in Physics only two years ago, that there are two types...

Im Focus: Researchers develop method to transfer entire 2D circuits to any smooth surface

What if a sensor sensing a thing could be part of the thing itself? Rice University engineers believe they have a two-dimensional solution to do just that.

Rice engineers led by materials scientists Pulickel Ajayan and Jun Lou have developed a method to make atom-flat sensors that seamlessly integrate with devices...

Im Focus: Three components on one chip

Scientists at the University of Stuttgart and the Karlsruhe Institute of Technology (KIT) succeed in important further development on the way to quantum Computers.

Quantum computers one day should be able to solve certain computing problems much faster than a classical computer. One of the most promising approaches is...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

ICTM Conference 2019: Digitization emerges as an engineering trend for turbomachinery construction

12.12.2018 | Event News

New Plastics Economy Investor Forum - Meeting Point for Innovations

10.12.2018 | Event News

EGU 2019 meeting: Media registration now open

06.12.2018 | Event News

 
Latest News

New discoveries predict ability to forecast dementia from single molecule

12.12.2018 | Health and Medicine

CCNY-Yale researchers make shape shifting cell breakthrough

12.12.2018 | Physics and Astronomy

Pain: Perception and motor impulses arise in the brain independently of one another

12.12.2018 | Health and Medicine

VideoLinks
Science & Research
Overview of more VideoLinks >>>