The authors respond to “Inconsistencies in the 2017 Canadian Guideline for Opioids for Chronic Noncancer Pain”

Abstract

for each recommendation provides greater detail. Accordingly, the summary statements for the sixth and seventh recommendation advise: "A clear doseresponse relationship was demonstrated for the outcomes of fatal and nonfatal overdose." The key information section provides more detailed statements for each outcome, with the accompanying estimates of association. We have removed the qualifier "clear" from the summary statement (in the MAGICapp version of the guideline) to address any perceived inconsistency.

Chronic pain management and the development of opioid use disorder

“…1 The number of prescription opioid-related deaths rose to one in every thirty-two patients when more than 200 mg of morphine equivalent dose (MED) was prescribed daily.…”

“…Despite a lack of evidence for effective treatment of chronic non-cancer pain using long-term opioid prescription, 13% of Ontarians report use of prescription opioids for pain relief, 5.5% of whom are expected to be at risk of addiction. 1,4 As well, highdose opioid prescribing has continued to rise despite the evidence that risks of fatal and non-fatal overdose increase substantially with dose size. 1 Risk to the public is further exacerbated by physicians' failure to recognize double-doctoring and consequent drug diversion.…”

“…1,4 As well, highdose opioid prescribing has continued to rise despite the evidence that risks of fatal and non-fatal overdose increase substantially with dose size. 1 Risk to the public is further exacerbated by physicians' failure to recognize double-doctoring and consequent drug diversion. 5 In a 2015 study conducted in collaboration with the Center for Addiction and Mental Health (CAMH), 37% of patients admitted for prescription opioid dependence reported having obtained opioids from physicians only, 26% used both prescribed and diverted opioids, and an additional 21% obtained prescription opioids from the street alone.…”

“…In Canada, chronic non-cancer pain plagues up to 19% of people, 25% of whom report having pain for greater than 20 years and 50% of whom report having pain for longer than a decade. 1 Within the context of Western medicine, prescription opioids have become a mainstay in the medical management of chronic pain. In Canada, prescription opioid consumption increased by 155% between 2000 and 2011, and the number of annual opioid…”

Researching what matters to improve chronic pain care in Canada: A priority-setting partnership process to support patient-oriented research

“…[14][15][16] Between 35% and 50% of people living with chronic pain experience depression or anxiety, 17,18 and chronic pain is associated with increased risk of suicide. 19 Problematic use of substances is also a concern 19 ; Canada has the second highest per capita rate of opioid prescribing in the world, 20 and moderate quality evidence suggests that prescription of opioids for chronic non-cancer pain is associated with a 5.5% risk of opioid use disorder. 21 Despite its enormous costs, until recently, less than 0.25% of all health research funding was directed toward chronic pain in Canada.…”