Prescription Opioid Advice​

Prescription opioid misuse has become a major public health problem. The resources below provide information on the use of opioids for the treatment of pain as well as ways to prevent, assess, and manage those who have become addicted.  

Opioid Advice

• Detection and Management of Acute Opioid Intoxication
• Detection and Management of Acute Opioid Withdrawal in Non-Pregnant Patients Prescribed Opioids for Chronic Pain
• Management of Opioid Dependence in Pregnancy and of Neonatal Abstinence Syndrome (NAS)
• Switching Opioids Safely to Prevent Overdose for Outpatients Prescribed Opioids for Chronic Pain

Clinical Practice Tips Videos 

Effective Tapering Strategies for Prescription Opioids
In this series of four videos for family physicians and other health care practitioners, Dr Peter Selby, Chief of the Addictions Division at CAMH presents guidance on tapering opioids from the Canadian Guidelines for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.  

1. Key Messages (2:53) 
2. Main Reasons to Discontinue Opioids (4:59) 
3. Clinical Considerations (6:11) 
4. Opioid Tapering Protocol (13:06) 

Resources

Treatment Guidelines 

• Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guideline PDF
  The Guideline provides clinical recommendations for the initiation, maintenance and discontinuation of buprenorphine/ naloxone maintenance treatment in patients with opioid dependence in Ontario. The guideline will help educate practitioners in opioid prescribing, improve access to treatment for opioid dependence and lead to the safer prescribing and dispensing of buprenorphine/ naloxone.
• Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain 
  This guideline was developed to help physicians determine who to put on prescription opioids for chronic non-cancer pain; how to titrate the dose; how to monitor long-term opioid therapy; and how to appropriately cease or change opioids. There are 24 recommendations based on graded scientific evidence.
  The guideline also includes several clinical tools, including the Opioid Manager tool (registration required).
• Addiction Toolkit: Opioid Misuse and Addiction 
  This section of the toolkit provides a comprehensive overview of what primary care providers need to know about opioid misuse and addiction. This includes:
  • which patients are most at risk of addiction
  • how to adequately monitor these and other patients receiving opioids for chronic non-cancer pain
  • how to treat pain in people who are known to be addicted to opioids.

Consulation and Treatment Services

• Addiction Clinical Consultation Service (CAMH)
  For professional consultation to help your client or patient with opioid and methadone problems, call: 1-888-720- 2227
• ConnexOntario
  ConnexOntario is funded by the Ministry of Health and Long Term Care and provides information and referral to alcohol and drug (Drug and Alcohol Helpline), gambling and mental health treatment services in Ontario.

Online Training

• Opioid Dependence Treatment Certificate Program (CAMH)
  This certificate program is held under the auspices of the Office of Continuing Education and Professional Development, The Faculty of Medicine, University of Toronto and the Centre for Addiction and Mental Health.
  The Opioid Dependence Treatment Certificate Program has been developed to prepare physicians, pharmacists, nurses and counsellors to provide a comprehensive range of services for people with opioid dependence. The certificate program consists of  the Opioid Dependence Treatment Core Course (ODT) and six elective courses.

Research 

• Brands, B., Paglia-Boak, A., Sproule, B.A., Leslie, K., Adlaf, E.M. (2010) Nonmedical use of opioid analgesics among Ontario students. Canadian Family Physician, 56 (3), 256-62. 
  OSDHUS survey results show that 21% of Ontario students reported non-medical use of prescription opioids at least once in the past year. Among those students, 72% reported obtaining them from home. These students also showed higher past-year rates for alcohol, daily smoking and other illicit drug use.  
• Dhalla, I.A., Mamdani., M.M., Sivilotti, M.L.A., Kopp, A., Qureshi, O., & Juurlink, D.N. (December 8, 2009) Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ, 191, (12) 891-896. 
  This article examines the increase in opioid-related mortality in Canada, "the extent of the problem and the impact of the introduction of long-acting oxycodone" (which was added to the provincial drug formulary in 2000.
• Fischer, B., Nakamura, N., Rush, B., Rehm, J., & Urbanoski, K. (2010) Changes in and characteristics of admissions to treatment related to problematic prescription opioid use in Ontario, 2004-2009. Drug and Alcohol Dependence, 109, 257-260. 
  The number of prescription opioid-related treatment admissions in Ontario (using DATIS data) increased from 9.4% in 2004/05 to 15.7% in 2008/09. The majority of these also reported other problematic substance use.
• Fischer, B., Rehm, J., Patra, J. and Firestone Cruz, M. (2006) Changes in illicit opioid use across Canada. Canadian Medical Association Journal 175 (11) 1385-1387. 
  This paper reports on the shift from heroin to prescription opioid use among a cohort of regular illicit opioid users not in treatment in 5 of 7 Canadian cities studied. 
• Osborne TL, Raichle KA, Jensen MP (2006) Psychologic interventions for chronic pain. Physcial Medicine & Rehabiliation Clinics of North America. 17 415–433. 
• Sproule BA, Brands B, Li S, Catz-Biro L. (2009) Changing patterns in opioid addiction: Characterizing users of oxycodone and other opioids. Canadian Family Physician 55 (1), 68-9.e1-5. 
  From 2000 to 2004, the number of opioid admissions to CAMH's opioid detoxification program related to controlled-release oxycodone increased substantially, from 3.8% in 2000 to 55.4% in 2004. The main source of prescriptions was doctors' prescriptions. The rates of admissions involving heroin remained low and stable.
• Tan, G, Craine, MH,  Bair, MJ, Garcia, K Giordano, J. Jensen,  et al (2007) Efficacy of selected complementary and alternative medicine interventions for chronic pain. Journal of Rehabilitation Research & Development Volume 44, Number 2, 195-222 

Reports

• Report of the Methadone Maintenance Treatment Practices Task Force
• Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) 2010
• Avoiding Abuse, Achieving a Balance: Tackling the Opioid Public Health Crisis (College of Physicians and Surgeons of Ontario)

Information for the Public

• New Video Gives the Best Advice for People Considering or Taking Opioid Medications
  The Centre for Addiction and Mental Health, Dr. Mike Evans, Mercury Films and Canada Health Infoway are very proud to launch a new video that tackles the question, what is the best advice for people on, or about to start, opioid medications? Watch the video online.
• Prescription for Addiction  
  A documentary that examines the growing problem of dependence and addiction to opioid pain medications. This 39-minute video includes insights from doctors and health professionals. The kit available from CAMH comes with a DVD and a comprehensive User Guide offering support for facilitators, teachers and others wishing to screen the film in their communities. Watch the video online.
• Methadone Maintenance Treatment: Client Handbook (CAMH)  
  This book should answers many of the questions clents have about methadone treatment, and can help them to know what questions they should ask their doctor, pharmacist, counsellor and others. There's information here for those thinking about methadone treatment, for the new client and the long-term client, and for families and friends.

Brochures

• About...percs, Oxys and other pain pills (free download from the CAMH Store) 
• Straight Talk: Oxycontin (CAMH) 
• Straight Talk: Street Methadone (free download from the CAMH Store) 
• Do you know...Heroin (free PDF download from the CAMH Store) 
• Do you know...Methadone (free PDF download from the CAMH Store) 
• Do you know...Opioids (free PDF download from the CAMH Store) 
• Methadone Maintenance Treatment: Information for Clients (CAMH) 

FAQs

• Ontario's Narcotics Strategy: Change in Funding Status of Oxycodone Controlled Release Tablet (Ontario Ministry of Health and Longterm Care)
• Prescription Drug Abuse (Canadian Centre on Substance Abuse)
• OxyContin (Canadian Centre on Substance Abuse)
• Opioid Pain Medications: Frequently Asked Questions (Health Canada) 

The Opioid Advice series was produced in collaboration with the Ministry of Health and Long-Term Care.