Opioids are drugs such as morphine, codeine and oxycodone that are used to relieve pain. They are addictive, potentially lethal and widely used. In 2008, Canada had the highest per capita rate of oxycodone consumption in the world, according the International Narcotics Control Board. In Ontario, opioid-related deaths climbed to 33.3 deaths per million people per year in 2006, up from 19.4 in 2000.
Over the last decade, the number of opioid prescriptions to workers receiving workers’ compensation benefits has gone up by 100 per cent. According to the Workplace Safety and Insurance Board, 40 per cent more workers are now prescribed these drugs compared to 10 years ago.
However, the instrumental work of the Institute for Work & Health (IWH) in the development of a national guideline and tool promoting safe opioid use may help prevent opioid overuse and related deaths in future.
IWH provides research to guideline development
In 2007, physician regulatory colleges across Canada came together to update guidelines on opioid use and chronic pain. Collectively, they formed the National Opioid Use Guideline Group (NOUGG). In May 2010, NOUGG released the new Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-cancer Pain.
The research team behind the guideline was led by IWH Associate Scientist Dr. Andrea Furlan and included IWH Director of Research Operations Emma Irvin. As reported on McMaster University’s National Pain Centre website (which houses the guideline), IWH contributed its expertise
to oversee the systematic review process from literature search to data extraction.
Dr. Furlan then went on to lead to development of the Opioid Manager, a tool designed to help doctors when prescribing opioids. The tool is a user-friendly, double-sided, colour-coded chart that condenses the key elements of the 200-page guideline. It is also available as an app.
Guideline and tool widely disseminated
The guideline and tool proved to be very popular. As of March 2012, the landing page for the guideline on the National Pain Centre website had been viewed 86,972 times, and the Opioid Manager web page had been viewed 22,142 times. As well, as of the same date, 3,327 people had registered to download the tool, and 1,942 people had viewed the Opioid Manager video available on the MacHealthSci YouTube channel.
The guideline and tool are also proving to be useful, according to health-care practitioners who have used them. One of them is Dr. Peter MacDougall, director of the Nova Scotia Chronic Pain Collaborative Network, a medical consultant with the Nova Scotia Prescription Monitoring Program and an associate professor in the Department of Anesthesia and Family Medicine at Dalhousie University in Halifax.
MacDougall says he refers to the guideline in three ways: as a clinician when prescribing to patients in his own pain practice, as an educator when teaching residents in the university’s chronic pain clinic and, most importantly, as the medical consultant to the province’s prescription monitoring program, which oversees the prescribing of all federally designated drugs, including opioids.
I am in contact with physicians through the monitoring program in three ways, MacDougall explains.
They contact me when they are having a problem prescribing, or the program identifies a concern and I contact them, or they attend one of the education meetings that we hold around the province. I use the guideline and Opioid Manager in all three contexts.
MacDougall says he also likes the guideline when talking more broadly about prescribing practices in general.
This is one of the most useful guidelines I have ever seen, he says.
It outlines good practices that should be used when prescribing drugs beyond opioids.
IWH associate scientist becomes subject expert
Furlan’s pivotal role in the development of the guideline and related tool made her a much sought-after subject-matter expert. In November 2011, Furlan took part in a town hall meeting in Brockville, Ontario on the use and abuse of prescription pain medication. Hosted by Dr. Brian Goldman of the CBC Radio One program “White Coat, Black Art,” the town hall was recorded and aired nationally on Goldman’s show twice the following month: as part of a regular show and, due to what CBC calls “the incredible response” to the first show, as a one-hour special (http://www.cbc.ca/whitecoat/blog/2011/12/27/generation-rx-one-hour-special/).
That same month, Furlan also took part in a CIHR Café Scientifique—the Canadian Institutes for Health Research’s informal get-togethers at which the public and experts in a given field gather at a café, pub or restaurant to discuss a specific subject. In this case, the café debated the use of opioids in chronic pain management (http://www.youtube.com/watch?v=KBzfVovH6Qk).