Abstract

Chronic pain affects one in five Canadians, and opioids continue to be prescribed to 12.3% of the Canadian population. A survey of family physicians was conducted in 2010 as a baseline prior to the release of the Canadian Opioid Guideline. We repeated the same survey with minor modifications to reflect the updated 2017 opioid prescribing guideline. The online survey was distributed in all provinces and territories in both English and French. There were 265 responses from May 2018 to October 2019, 55% of respondents were male, 16% had advanced training in pain management, 51% had more than 20 years in practice, 54% wrote five or fewer prescriptions of opioids per month, and 58% were confident in their skills in prescribing opioids. Of the 11 knowledge questions, only two were correctly selected by more than 80% of the respondents. Twenty-nine physicians (11%) do not prescribe opioids, and the main factor affecting their decisions were concerns about long-term adverse effects and lack of evidence for effectiveness of opioids in chronic noncancer pain. Of the 12 guideline-concordant practices, only two were performed regularly by 90% or more of the respondents: explain potential harms of long-term opioid therapy and beginning dose of less than 50 mg of morphine equivalent daily. This survey represents a small proportion of family physicians in Canada and its generalizability is limited. However, we identified a number of opioid-related and guideline-specific gaps, as well as barriers and enablers to prescribing opioids and adhering to the guideline.

Highlights

  • Chronic noncancer pain (CNCP) continues to be a major health problem affecting one in five Canadians [1]

  • Among people who died from illicit drug overdose in the Canadian Province of British Columbia between 2015 and 2017, 85.5% had opioids relevant to death on toxicology; of these, both prescribed-only opioids (2.4%) and a combination of prescribed and nonprescribed opioids (7.8%) were relatively rare, suggesting that the majority of opioids are from illicit sources [6]

  • Responses according to province were Saskatchewan, n = 117 (63%); Alberta, n = 30 (16%); British Columbia, 26 (14%); Ontario, 8 (4%); Manitoba, 2 (1%); Nova Scotia, 1 (1%); and Yukon, 1 (1%)

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Summary

Introduction

Chronic noncancer pain (CNCP) continues to be a major health problem affecting one in five Canadians [1]. The dosage and duration of opioid therapy among people starting opioids remained relatively stable [3]. Despite the reduction of available opioids in Canada, the number of opioid-related emergency visits, overdoses, and deaths continues to climb. Among people who died from illicit drug overdose in the Canadian Province of British Columbia between 2015 and 2017, 85.5% had opioids relevant to death on toxicology; of these, both prescribed-only opioids (2.4%) and a combination of prescribed and nonprescribed opioids (7.8%) were relatively rare, suggesting that the majority of opioids are from illicit sources [6]

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