Canada’s hidden opioid crisis: the health care system’s inability to manage high-dose opioid patients
Source: Canadian Family Physician (journal)
September 1, 2019
Abstract: Opioid overprescribing, a plausible result of disingenuous marketing practices, has played a role in our current opioid crisis. The release and implementation of the 2017 “Guideline for opioid therapy and chronic noncancer pain” has created a shift in opioid prescribing for chronic noncancer pain, and patients in the years ahead will be protected by the lower-dose recommendations.1 Physicians will shift their prescribing patterns and adhere to ceiling doses for new opioid initiations. They will potentially more often consider the use of alternative medications as first-line options for pain conditions, as opposed to opioids, which should be second- or third-line alternatives, if used at all for chronic noncancer pain. The evidence recommending nonopioid medications to be superior to opioid medications for chronic noncancer pain can (similarly to the evidence for opioid superiority) be criticized for not having adequate long-term follow-up, for small sample sizes, and for a lack of functional outcome data. However well meaning they are, the 2017 Canadian opioid prescribing guidelines were introduced to a health care system ill equipped to care for patients with chronic pain.