Opioids and Pain Management
(On Friday, March 9, 1:30 pm ET, join Health Quality Ontario CEO Dr. Joshua Tepper, and VP of Evidence Development and Standards Dr. Irfan Dhalla, for a tweet chat to discuss the opioid crisis and pain management)
In a recent panel discussion sponsored by Health Quality Ontario, Dr. David Juurlink, head of the Clinical Pharmacology and Toxicology division at the University of Toronto, noted that there is no single opioid crisis in Ontario but rather:
- A crisis of opioid overdoses and deaths
- A crisis of opioid addiction
- A crisis of tainted illicit drugs
- A crisis in chronic pain management
- A crisis in scarce health care resource allocation
- A crisis in Indigenous health equity
To bundle all of this together and call it "the opioid crisis" may be a useful form of shorthand but it also masks the complexity of the current situation and puts us a risk of failing to address the many issues we need to work together to fix.
Dr. Juurlink said that, although it was easy to blame the pharmaceutical companies and their advocates who had persuaded physicians to prescribe opioids more liberally, the main focus should now be on helping people who are living with acute or chronic pain and those who have developed an opioid use disorder.
There are cascading benefits from providing high-quality health care at every point in this complex area:
- Making better use of non-medical treatments to manage both acute and chronic pain will reduce the number of people who end up using opioids for the long-term, and also reduce the amount of prescription opioids that end up being used in harmful ways.
- Prescribing opioids at lower doses and for shorter durations than many of us have grown used to.
- Asking patients how they use opioids, in a compassionate and non-judgmental manner, to identify patients with opioid use disorder so they can be offered evidence-based health care.
Many people who suffer from chronic pain fear being abruptly denied opioid medications as a result of the current focus on opioid overdoses and addiction. The anxieties faced by patients dealing with chronic pain are mirrored by those of physicians who fear disciplinary action or harming patients if they do not prescribe opioids appropriately.
Health Quality Ontario is in the process of releasing three quality standards to show patients and clinicians what quality care looks like in managing chronic pain, acute pain, and opioid use disorder, respectively. The standards are part of a comprehensive provincial strategy that aims to curb "the opioid crisis" that is resulting in so much harm and loss of life.
Join us on Twitter at #HQOchat on Friday, March 9 at 1:30pm ET when we will moderate a discussion framed by the following questions. Please remember to use the hashtag for your comments and answers:
1. How has "the opioid crisis" touched you?
2. What role is there for opioids in managing chronic pain?
3. What non-medical treatments are of value in managing acute or chronic pain?
4. What could we be doing so that we can use opioids more safely?
5. What can we do to provide better care to people with opioid use disorder and those who are at risk of overdose?