Questions for the Scientific Advisory Panel on Opioid Use and Contraindications (SAP-OUC)
March 24, 2017
- Specific to the threshold dose:
- Should a threshold dose (50 and/or 90 morphine milligram equivalents), as discussed in the recommendations of the new proposed Canadian guideline on the use of opioids for chronic non-cancer pain, be included in the Product Monograph (PM)?
- Where should the information on the threshold dose be included in the PM (e.g. in the Warnings and Precautions or Dosing and Administration section)?
- Should the threshold dose information be emphasized by bolding it or placing it in a box?
- Do you think it should be specified that the threshold dose does not apply in end of life care, cancer pain and other similar situations, or is this self-evident?
- Specific to the indication and clinical use:
- Do you think the current indication for the extended/long-acting opioidsFootnote 1 is clearly worded and in line with the recommendations in the new guidance (i.e., opioids should not be considered as a first line treatment)? Should the indication be reworded to put more emphasis on the fact that opioids are not first line therapy?
- Do you think the indication for immediate release opioidsFootnote 1 should limit the duration of use (e.g. to 7 or 14 days), and consequently the amount of medicine that should be dispensed to patients?
- Should dosing instructions for stopping the opioid treatment after a few days to evaluate the need to continue treatment, be part of the PM?
- Should a recommendation to consider tapering patients who are using chronic high doses of opioids be added to the PM?
- Some studies have shown that opioids have marginal efficacy when used for lower back pain. Should information from these published articles be added to the PM?
- Specific to contraindications:
- In addition to the current contraindications and in light of the draft guideline recommendations, should there be a contraindication or a relative contraindication for patients with:
- A history of addiction?
- An uncontrolled mental illness?
- Is the contraindication on Labour, Delivery and Nursing Women compatible with the practice of medicine (i.e. use of opioids during labour and delivery)Footnote 3 and with the language used in the Warnings and PrecautionsFootnote 4?
- Are there any other contraindications, relative contraindications, or limitations in use that you feel are missing and should be added to the PM?
- Does the information in the PM provide prescribers and patients with adequate/sufficient information on the risks of opioids?
- There are situations where potential contraindications or limitations should perhaps not apply (e.g. trauma or cancer in a patient with previous addiction problems). Do you think that these situations are self-evident, or should they be described in the PM?
- Specific to low-dose codeine products:
- Currently, low-dose codeine products are exempted from the Controlled Drugs and Substances Act (CDSA) and can be obtained without a prescription. Do you believe there would be merit in making these products prescription only, considering: the risks and benefits for patients, the impact it could have on patients and the health care system, etc.?
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