Will the new CDC guidelines for opioid prescribing be helpful in changing your prescribing practice?

College of Physicians and Surgeons of Alberta CPSA, Designing Quality, Designing Quality Blog 14 Comments

The Centre for Disease Control (CDC) recently issued guidelines that reduce limits to appropriate and safe opioid prescribing for chronic pain patients. While awaiting the updated Canadian guidelines, College Council endorsed the CDC guidelines in May, signaling a fundamental change in thinking.

Evidence shows us that long-term use of opioids to treat chronic pain may not be as effective as other options, and may pose a serious risk to our patients. Physicians have to have tough conversations with their patients about what they can and cannot accomplish with opioid treatment, and encourage safer and more effective options.

Click here to visit the Opioid Prescribing Forum page.

We invite you to share your comments below.

“The new CDC guidelines are a good opportunity to open this discussion with our patients, set clear boundaries, and move
toward a safer, more appropriate treatment plan.”Dr. Monica Weller, CPSA Senior Medical Advisor

About Dr. Weller:
Dr. Monica Weller, a rural family physician for 28 years, brings office and hospital based clinical experience, including teaching medical students and mentoring residents. Dr. Weller supports physicians as a Senior Medical Advisor with the College.

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Dean Grant Baker

Any medical scientist that states, “mindfulness”, reiki, acupuncture or CBT; should lose their scientific medical license, the right to call themselves a medical scientist and should be re-labled: Quack.

mindfulness and wholly disredited CBT and, acupuncture? Seriously?

Some scientists.

Deon Louw

My practice is devoted to management of chronic pain patients, with an accent on spine intervention and headache. The International Classification of Headache Disorders states that regular use of opioids is a major risk factor in the chronification of headache: “Diagnostic criteria: Headache fulfilling criteria A, C and D for 8.2 Medication-overuse headache Opioid intake on ≥10 days/month on a regular basis for >3 months Comment: Prospective studies indicate that patients overusing opioids have the highest relapse rate after withdrawal treatment.” I have always wondered why our non-headache chronic pain patients are often not initially prescribed intermittent opioids, as this… Read more »

Esprin Reddy

The comments made by my colleagues are very pertinent and relevant to the complex problem of treating non malignant chronic pain. Many years ago I participated in a study whose aim was to determine which type of patients used opioid narcotics for chronic benign pain. We found that a significant number of these patients suffered from depression and other psychological issues due to previous history of abuse in childhood . There was also a concomitant higher incidence of chronic anxiety and stress and insomnia. We concluded that many patients needed a psychiatric evaluation as part of the treatment of chronic… Read more »

David Lardner

As an anesthesiologist dealing predominantly with acute pain, I am concerned that the vilification of opioids for chronic pain will have a spillover effect in the management of acute surgical pain. I would hate to see us go back to the 70s and early 80s when acute surgical pain was under treated. With the push to earlier discharge of surgical patients postoperatively, it is important for us not to withhold prescribing opioids to these patients because they are at home rather than in hospital.

d

This reply is addressed to the College of Physicians and Surgeons. Because of the demonization (vilification) of Oxycodone, I can’t even get my prescription for 60 mg of Codeine switched to the equivalent dose of Oxycodone, which is only 8.33 mg of Oxycodone!! WELL BELOW the guidelines of <50 mg equivalent of morphine. No doubt I am just another junkie aboriginal wanting a drug with a dirty name! I understand that drug addicts and drug dealers have made things difficult for everyone, I get it, but to equate humane pain relief to drug addiction, and to deprive responsible patients from… Read more »

Robert Hauptman

I appreciate the comments that have been posted so far and I also appreciate the leadership of the CPSA in this area. However, I think what often gets lost in the discussion is that there are really two issues here and two distinct patient populations. The two issues are really how do we manage patients with chronic pain effectively and how to we manage patients with substance abuse disorder. The question of how to effectively manage chronic pain patients is complex. There are no Canadian or American guidelines on how to manage chronic pain patients (although there are guidelines on… Read more »

Das Madhavan

Glad to see this cancerous physician issue is taken up seriously by the CPSA, hats off to the initiators. Yes CDC guidelines are quite helpful. But the question we are reluctant to answer when a behavior is flawed is ” Who and what perpetuates the flawed behavior ? “. We are unconsciously / subconsciously avoiding this key question, since the answers might put us, the prescribers in the limelight, and in a difficult predicament further projecting our own ethics in prescribing. Hakique and Scott has outlined some of the key issues already. My suggestion is to focus on negatively reinforcing… Read more »

Jim Adams

When I was advised to attend a conference in Nashville on opiod prescribing by the CPSA, the conference leader started the three day seminar by asking doctors where they were from. The other 12 doctors were all from the USA and when I said I was from Canada, he stated, “The number one cause of drugs on the streets in the USA is physicians. BUT, in Canada the number one cause is mofia and street drugs. Physicians are NOT the problem in Canada due to the triplicate programs and rules.” Nice to know that physicians aren’t the problem, but the… Read more »

Noel Hershfield

So many patients that I saw when I was an active practice, were referred for chronic abdominal pain. Many of them, too many of them were already taking narcotics for the relief of the pain, the cause of which was unknown. Therefore I did whatever appropriate investigation we could find based on a careful physical examination and history. At least 20% of the patients that I saw suffering from abdominal wall pain and I reported that series of cases. If we could not find the causes of pain tried everything that was possible in order to get relief before continuing… Read more »

Brian Knight

We do have to accept that the prescription of opioids in chronic pain remains controversial and we have to accept that some of the opioids being abused on the street are coming from prescriptions written in good faith by doctors. At the same time proscribing one aspect of chronic pain practice without a parallel increase in the resources available to treat these patients and without increasing the education of physicians in treating pain is short sighted.

Karen Mazurek

The CPSA recognizes that there are many factors contributing to this crisis. Our jurisdiction is over the actions of individual physicians and, as a result, we are developing strategies to inform and support physicians with prescribing data and educational support. We want all physicians to prescribe responsibly. Having said that, I completely agree with the above comments regarding advocacy for more resources for patients and physicians for treatment of opioid use disorder and non pharmacological treatment for chronic pain. CPSA’s mandate is to ensure patients receive high quality care from physicians. We know physicians need access to these resources to… Read more »

Trevor Theman

I offer my thanks to Scott and Hakique for their comments and perspectives. As Hakique points out, we have an obvious societal problem (opioid use and abuse) that has a medical component , both in its initiation (where we can have a very significant impact) and treatment (where we can advocate for better access to treatment and where we can provide care for patients). One of the College’s goals is to help our members use opioids and other drugs of potential abuse as rationally as possible. The Council has endorsed the new CDC guideline, which is a signal to the… Read more »

Scott A. Lang

August 11, 2016 Opioid Use: Very well said. I remember as a young doctor (35 years ago) being labelled an expert in the management of chronic pain and tasked with helping complex patients. I felt overwhelmed. The patients I saw were desperate. They were frustrated with the medical system. I had no magic solution but felt intense pressure to do something. I recognized the complexity of each situation but had little knowledge and limited access to supplementary resources. It seemed to me that I was their last hope and everyone was counting on me – a very uncomfortable scenario. I… Read more »

Hakique Virani

This is a topical issue, indeed, with opioid overdose death now the number one cause of unintentional injury/poisoning death in Alberta – outpacing motor vehicle collision deaths, the previous perennial leader. I think it is right for our Colleges nationally to be concerned with this top public health concern mostly because it affects all of our patient populations, but also because our opioid prescribing has been a factor both in individual cases of adverse outcomes and in the epidemiological picture. While the adverse outcomes of opioid exposure that receive most attention are addiction and overdose death, there are plenty of… Read more »