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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.


Comprehensive Assessment

People with chronic pain receive a comprehensive assessment, including consideration of their functional status and social determinants of health.

Prior to considering opioid therapy, health care professionals caring for people with chronic pain should consider relevant physical and/or psychological diagnoses and document an assessment of the person’s health history and comorbidities, using validated tools to assess functional status, quality of life, and pain. Alternative or adapted assessment tools should be used for people who cannot self-report.

A person’s access to resources plays a large role in their ability to receive health care, engage in healthy lifestyle behaviours, and participate in chronic pain management plans. Therefore, clinicians should also examine socioeconomic factors in a person’s life, including the social determinants of health, as part of a comprehensive assessment.

For Patients

Your health care professional should ask you about your pain, your health, your ability to function at work and at home, and any other issues that may be affecting your health.

For Clinicians

Conduct a comprehensive assessment (see definition) for people with chronic pain who are taking or for whom you are considering prescribing opioids. This assessment should include consideration of functional status and social determinants of health. Use alternative or adapted assessment tools to assess people who cannot self-report pain or functional status.

For Health Services

Ensure systems, processes, and resources are in place to allow clinicians to perform comprehensive assessments of people with chronic pain. This includes providing the time required to perform a comprehensive assessment, including history, and ensuring access to assessment tools and, where available, electronic medical histories and patient records.

Process Indicator

Percentage of people with chronic pain prescribed an opioid who received a comprehensive assessment (see definition) prior to being prescribed opioid therapy

  • Denominator: total number of people with chronic pain who were prescribed an opioid and did not have an opioid prescription in the previous 6 months
  • Numerator: number of people in the denominator who received a comprehensive assessment (see definition) prior to being prescribed opioid therapy
  • Data source: local data collection
Comprehensive assessment

A comprehensive assessment includes an assessment of the following:

  • The pain condition: anatomical site and frequency and severity of pain
  • Any other medical conditions
  • Psychosocial history, including history of trauma
  • Mental health status
  • Medication and substance use history
  • Functional status
  • Sleep patterns
  • Past and current substance use disorders
  • Past pain management and coping strategies

Functional status

Functional status is a person’s ability to perform activities of daily living, including work, play, and socialization. Assessment of functional status is preferably performed using a validated measure.

Social determinants of health

The social determinants of health are factors that affect the ability of a person to access or receive high-quality health care, creating unfair and avoidable differences in health status. The social determinants of health include, but are not limited to, the following:

  • Culture
  • Education
  • Employment
  • Ethnicity
  • Family and social support
  • Geographic location
  • Housing
  • Income
  • Transportation and access to health care facilities


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