Country in crisis: New opioid prescribing guidelines released

A team led by researchers from McMaster University has released new guidelines for prescribing opioid painkillers, in an effort to curb surging overdose rates across the country.

The new guidelines were developed in light of Canadians being the second highest users per capita of opioids worldwide, with rates of opioid prescribing by doctors and opioid-related hospital visits rising rapidly.

• Did 2 people die in Hamilton of fentanyl overdose in February? We may not know for a year
• 'It's everywhere': A former opioid dealer says Hamilton is full of fentanyl

"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, and associate professor of anesthesia of McMaster's Michael G. DeGroote School of Medicine.

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

The guidelines were published by the Canadian Medical Association Journal (CMAJ) Monday. They are recommendations for doctors, but not regulatory requirements.

The recommendations include:

• Non-drug and non-opioid options be considered for patients first, rather than a trial of opioids.
• A trial of opioids occur only for patients who haven't responded to non-opioid treatment, and who do not have any substance or psychiatric disorders.
• That doses be restricted to under 50 mg morphine equivalents a day to start, with a "strong recommendation" that daily doses come in under 90 mg a day.

Opioid addiction is a pronounced problem in Hamilton.

There have beenmore opioid-related deaths in the Hamilton LHINover a five-year period than anywhere else in the province, according to a recent study from the Institute for Clinical Evaluative Sciences.

How does it feel to be hooked on opioids?

11 years ago

Duration 3:57

Former opioid addict Nicole and Debbie Bang, the manager of St. Josephs Healthcare Womankind addiction service, explain prescription painkiller addiction.

The report also shows that the Hamilton LHIN (which includes Niagara, Haldimand and Brant) had the highest number of opioid-related hospital admissions and emergency department visits in the entire province in 2014.

According to preliminary reports from the provincial coroner's office, there were 47 deaths in Hamilton caused by opioids or a combination of opioids and alcohol in 2015.

In 2017, Hamilton paramedicsresponded to101 calls related to opioid overdoses as of April 30. And emergency room visits by patients seeking care for drug misuse or overdose were up inthe last week of April, according to the city's opioidmonitoring statistics site.

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