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Evidence to Improve Care

Opioid Prescribing for Chronic Pain

Care for People 15 Years of Age and Older

Click below to see a list of brief quality statements and scroll down for more information.

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Comprehensive Assessment
People with chronic pain receive a comprehensive assessment, including consideration of their functional status and social determinants of health.

Quality Statement 2: Setting Goals for Pain Management and Function
People with chronic pain set goals for pain management and functional improvement in partnership with their health care professionals. These goals are evaluated regularly.

Quality Statement 3: First-Line Treatment With Non-opioid Therapies
People with chronic pain receive an individualized and multidisciplinary approach to their care. They are offered non-opioid pharmacotherapy and nonpharmacological therapies as first-line treatment.

Quality Statement 4: Shared Decision-Making and Information on the Potential Benefits and Harms of Opioids for Chronic Pain
People with chronic pain, and their families and caregivers receive information about the potential benefits and harms of opioid therapy for chronic pain at the time of both prescribing and dispensing so that they can participate in shared decision-making.

Quality Statement 5: Initiating a Trial of Opioids for Chronic Pain
People with chronic pain begin a trial of opioid therapy only after other multimodal therapies have been tried without adequate improvement in pain and function, and they either have no contraindications to opioid therapy or have discussed any relative contraindications with their health care professional.

If opioids are initiated, the trial starts at the lowest effective dose, preferably below 50 mg morphine equivalents per day. Titrating over time to a dose of less than 90 mg morphine equivalents per day may be warranted in selected cases in which people are willing to accept a higher risk of harm for an improved pain relief.

Quality Statement 6: Co-prescribing Opioids and Benzodiazepines
People with chronic pain are not prescribed opioids and benzodiazepines at the same time whenever possible.

Quality Statement 7: Opioid Use Disorder
People prescribed opioids for chronic pain who are subsequently diagnosed with opioid use disorder have access to opioid agonist therapy.

Quality Statement 8: Prescription Monitoring Systems
Health care professionals who prescribe or dispense opioids have access to a real-time prescription monitoring system at the point of care. Prescription history is checked when opioids are prescribed and dispensed and every 3 to 6 months during long-term use, or more frequently if there are concerns regarding duplicate prescriptions, potentially harmful medication interactions, or diversion.

Quality Statement 9: Tapering and Discontinuation
All people with chronic pain on long-term opioid therapy, especially those taking 90 mg morphine equivalents or more per day, are periodically offered a trial of tapering to a lower dose or tapering to discontinuation.

Quality Statement 10: Health Care Professional Education
Health care professionals have the knowledge and skills to appropriately assess and treat chronic pain using a multidisciplinary, multimodal approach; appropriately prescribe, monitor, taper, and discontinue opioids; and recognize and treat opioid use disorder.

Health Quality Ontario thanks the following individuals for their generous, voluntary contributions of time and expertise to help create this quality standard:

Jason W. Busse (co-chair)
Associate Professor
Department of Anesthesia, McMaster University

Claudette Chase (co-chair)
Sioux Lookout First Nations Health Authority

Bjug Borgundvaag
Mount Sinai Hospital

Lisa Bromley
Sandy Hill Community Health Centre

Marilyn Brown
Lived Experience Advisor

Fiona Campbell
Hospital for Sick Children

Hance Clarke
Toronto General Hospital, University Health Network

Lynn Cooper
Lived Experience Advisor
Canadian Pain Coalition

Cheryl Cullimore
Senior Advisor, Access to Care
Hamilton Niagara Haldimand Brant Local Health Integration Network

Ruth Dubin
Queen’s University

Scott Duggan
Queen’s University and Hotel Dieu Hospital Chronic Pain Clinic

Andrea Furlan
Toronto Rehabilitation Institute, University Health Network

Ada Giudice-Tompson
Lived Experience Advisor
Advocates for the Reform of Prescription Opioids

Tara Gomes
St. Michael’s Hospital

David N. Juurlink
Sunnybrook Health Sciences Centre and Institute for Clinical Evaluative Sciences

Alexandru Mera
William Osler Health System

Jordan Miller
Assistant Professor, Queen’s University

David Mock
Dental Surgeon
Royal College of Dental Surgeons of Ontario

Rupa Patel
Kingston Community Health Centres

Calvin Pelletier
Nurse Practitioner
North West Local Health Integration Network

Monakshi Sawhney
Nurse Practitioner
Queen's University, Hotel Dieu Hospital, and North York General Hospital

Eldon Tunks
Regional Rehabilitation Centre, Hamilton General Hospital

Lindsay Yoo
Blue Skies Pharmacy and the Institute for Safe Medication Practices Canada

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