Health Canada's Statement on Opioids and Pain Management


November 7, 2022 | Ottawa, ON | Health Canada

Chronic pain is defined as pain that persists longer than 3 months. One in five Canadians, or nearly 8 million people, live with chronic pain. When not effectively managed, pain can have significant negative impacts on many aspects of an individual's life and on the lives of those around them.

Opioid medications are sometimes prescribed by health professionals to help manage pain. While opioids can offer benefits such as pain relief and increased function, they also come with potential harms. Increases in overdose and drug-related deaths in North America have heightened awareness around these risks.

In 2017, McMaster University published the Canadian Guideline for Opioids for Chronic Non-Cancer Pain, which provided prescribers and patients with recommendations on the use of opioids to manage chronic non-cancer pain. While the Guideline provided advice related to initiation and dosing, it noted that these guidelines should not be viewed as absolute and that no guideline can account for the unique features of patients and their clinical circumstances. A number of recommendations made as part of the Guideline were considered as "weak", reflecting that clinicians should recognize that different choices will be appropriate for individual patients.

The opioid overdose crisis and actions taken to mitigate opioid-related harms have led to unintended consequences for many people living with pain. Some Canadians have had difficulties accessing their opioid medications to help manage their pain, while others have had their opioid dose rapidly tapered or discontinued altogether. Increased stigma, anxiety, and fear surrounding opioid use for pain management has compounded these challenges and created additional barriers for people living with pain accessing the necessary services to manage their medical condition. Many Canadians living with chronic pain also face significant challenges in accessing a family physician. These challenges often limit their ability to access adequate pain management services, including non-pharmacological therapies and specialized pain services.

Efforts should be made to strike the right balance – to promote appropriate opioid prescribing practices that balance the uncertainties between the benefits and risks of these medications based on the individual needs of each patient. Medical needs of patients, including which prescription medications they should be taking, are best determined through shared decision-making between the patient and their health care provider, based on the unique needs of the individual.

Caution is strongly recommended when opioid tapering or discontinuation is being considered for individuals with physical dependence, given potential risks of severe withdrawal symptoms, increased pain, serious psychological distress and suicidal thoughts. Furthermore, when pain is unmanaged, people may seek other sources of opioids to manage their pain (e.g., opioids on the illegal market), which in turn increases the risks of overdoses and deaths. When tapering opioids, individuals who have been on high doses of opioids, or who have been taking opioids for an extended period of time will likely need to lower their opioid dose slowly and this process may take several months. Decisions about opioid tapering and discontinuation should be made jointly between the patient and their health care provider, tailoring to the unique needs of the individual and accompanied by appropriate monitoring of the patient. Formal multidisciplinary programs may also need to be offered for people experiencing serious challenges in tapering, although Health Canada recognizes that these programs may not be widely accessible across Canada.

Health Canada is committed to continue working with key stakeholders to advance priority actions identified by the Canadian Pain Task Force as part of the Action Plan for Pain in Canada. This includes taking action to increase available knowledge about resources and tools for both the public and health care providers, including those on the appropriate use of opioids for pain management. In July 2022, Health Canada announced funding to McMaster University to update the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, to incorporate new evidence, adopt new research methods, and incorporate feedback from stakeholders. The updated Guideline, expected to be finalized in 2023, will provide essential guidance to people living with chronic pain, and to the physicians, nurse practitioners, and pharmacists involved in their care.

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