Opioids Should Be Seen As A Last Resort For Chronic Pain Patients, Say Canadian Doctors

As North America grapples with an escalating opioid crisis, several prominent Canadian doctors say physicians need more support in treating chronic pain patients without prescribing them opioids.  

Dr. Peter Butt, addictions consultant for the Saskatoon Health Region in Saskatchewan, told CTV News that new national guidelines make it clear that physicians should only prescribe opioids as a last resort for patients with chronic pain.

"Which means that there needs to be better access to physical therapy, massage therapy and transcontinuous nerve stimulation," said Butt, who sits on a provincial committee that addresses fentanyl and opioid deaths.

"A lot of non-pharmacological interventions, which aren't readily available in the health-care system, need to be made more accessible to people that are struggling with chronic pain.

"If you constantly chase ... chronic pain, it'll just keep on coming back, and the dose of opioids will escalate and escalate to a point that there's a problem.”

The new national guidelines state that opioids like oxycodone, hydromorphone and the fentanyl patch should be limited to less than the equivalent of 90 milligrams of morphine a day, and ideally to less than 50 mg. Formerly, guidelines suggested doctors use a “watchful dose” the equivalent of 200 mg of morphine per day.

Opioids were responsible for roughly 2,500 overdose deaths in Canada in 2016. It’s been estimated that if the current trend continues, the country could be facing more than 3,000 deaths this year.

The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain includes a weak recommendation to taper opioids, meaning doses should be gradually reduced.

But Jason Busse, a researcher for the Michael G. DeGroote National Pain Centre and an assistant professor of anesthesia at McMaster University, said there are risks to tapering patients off the drugs too suddenly.

That means there needs to be safeguards against improper reduction, along with improved access to other kinds of therapies.

“There's at least a chance that in some cases the symptoms of withdrawal may be so unmanageable for patients that they might look to supplement their opioid through going to illicit sources and this obviously can have catastrophic consequences,” he said.

"If the resources aren't available, that can be a very difficult recommendation to implement and particularly in rural areas ... where perhaps resources are quite limited."

Medical marijuana's potential as an effective alternative to opioids has been well documented. 

h/t CTV News


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