Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians

Abstract

Background. Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective. In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results. We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. e majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. irty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion. ere was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.

The iatrogenic opioid crisis: An example of ‘institutional corruption of pharmaceuticals’?

“…Most were likely misled by views of upstream organizations and industry's marketing (category I‐III organizations) promoting CR oxycodone's long‐term effectiveness and safety even when given in high doses (discussed earlier) 53,60,65,97,127‐129 . Lack of access to non‐opioid treatments for pain was a barrier for health care professionals 123,130 …”

“…Direct consumer pharma‐marketing in some countries likely contributed 122,127,128 . Financial and health care access constraints or personal beliefs may have been barriers to seeking and receiving non‐pharmacological treatment 124,130 . Concomitant use of alcohol or other depressants contributed to AEs 27 .…”

“…53,60,65,97,[127][128][129] Lack of access to non-opioid treatments for pain was a barrier for health care professionals. 123,130 Individual professional-related factors contributing to AEs include: excess number of pills prescribed post-surgery, 7 failure to follow national guidelines for more judicious use, failure to screen for patients with OUD risk factors, co-prescribing depressant drugs like benzodiazepines and gabapentinoids, 11,15,26,27,56,131 and prescribing opioids to pregnant women or those of child-bearing age, [132][133][134] thereby also risking perinatal side-effects. 135,136 Unsafe and unethical practices of some physicians, clinics, drug distributors and pharmacists contributed to diversion for illicit use, 2,122,137 as could have drug losses from hospitals and pharmacies.…”

“…122,127,128 Financial and health care access constraints or personal beliefs may have been barriers to seeking and receiving non-pharmacological treatment. 124,130 Concomitant use of alcohol or other depressants contributed to AEs. 27 Some patients exaggerated or falsified pain to obtain opioids for personal illicit use or diversion.…”

Étude qualitative sur les facteurs qui entravent et ceux qui facilitent le travail des médecins de famille devant prescrire des opioïdes contre la douleur chronique non cancéreuse

“…Les dernières lig nes directrices canadiennes largement sui vies sur la prescription d'analgésiques opioïdes pour le traitement de la DCNC sont celles publiées par le National Pain Centre de l'Université McMaster en 2017 7 . Une étude de 2020 fondée sur une enquête portant sur l'incidence de ces lignes direc trices sur les médecins du Canada a révélé que les répondants la connaissaient en majorité et que, d'après certaines don nées, les médecins avaient adapté leurs pratiques pour mieux tenir compte des données probantes sur le traitement de la DCNC 8 . D'après des données de 2014 et 2015 sur l'Ontario, la majorité des ordonnances d'analgésiques opioïdes sont délivrées par des médecins de famille (38,4 %) et par des dentistes (16,7 %) 9 .…”