Abstract
Background Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.
Highlights
Canada is the world’s second largest per capita prescriber of opioids [1], and escalating rates of opioid overdoses and deaths [2], in conjunction with increased recognition of the limited effectiveness of opioids for chronic noncancer pain [3], have prompted concerns
In May 2017, the updated Canadian guideline for opioids for chronic noncancer pain was published in the Canadian Medical Association Journal (CMAJ) to promote evidence-based prescribing [4]
Materials and Methods rough a partnership between McMaster University and the CMA and with the assistance of pain physicians, methodologists, and members of the Pan-Canadian Collaborative for Improved Opioid Prescribing, we developed a 28-item English and French-language questionnaire to examine awareness and perceptions of the 2017 Canadian opioid guideline among Canadian physicians who prescribe opioids for chronic noncancer pain
Summary
Canada is the world’s second largest per capita prescriber of opioids [1], and escalating rates of opioid overdoses and deaths [2], in conjunction with increased recognition of the limited effectiveness of opioids for chronic noncancer pain [3], have prompted concerns. In 2018, the CMA, in partnership with McMaster University, surveyed Canadian physicians to determine their perceptions of the 2017 Canadian opioid guideline, and whether they had made changes in their management of chronic noncancer pain patients as a result of the guideline’s recommendations. Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed
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