Opioid Prescribing for Acute Pain

Care for People 15 Years of Age and Older

Click below to see a list of brief quality statements and scroll down for more information.

Quality Statements in Brief

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Comprehensive Assessment
People with acute pain receive a comprehensive assessment to guide pain management.

Quality Statement 2: Multimodal Therapies
People with acute pain receive multimodal therapy consisting of non-opioid pharmacotherapy with physical and/or psychological interventions, with opioids added only when appropriate.

Quality Quality Statement 3: Opioid Dose and Duration
People with acute pain who are prescribed opioids receive the lowest effective dose of the least potent immediate-release opioid. A duration of 3 days or less is often sufficient. A duration of more than 7 days is rarely indicated.

Quality Statement 4: Information on Benefits and Harms of Opioid Use and Shared Decision-Making
People with acute pain and their families and caregivers receive information about the potential benefits and harms of opioid therapy, safe storage, and safe disposal of unused medication at the times of both prescribing and dispensing.

Quality Statement 5: Acute Pain in People Who Regularly Take Opioids
People with acute pain who regularly take opioids receive care from a health care professional or team with expertise in pain management. Any short-term increase in opioids to treat acute pain is accompanied by a plan to taper to the previous dose.

Quality Statement 6: Acute Pain in People With Opioid Use Disorder
People taking buprenorphine/naloxone or methadone for the treatment of opioid use disorder continue their medication during acute-pain events.

Quality Statement 7: Prescription Monitoring Systems
Health care professionals who prescribe or dispense opioids have access to a real-time prescription monitoring system at the point of care. Prescription history is checked when opioids are prescribed and dispensed to avoid duplicate prescriptions, potentially harmful medication interactions, and diversion.

Quality Statement 8: Tapering and Discontinuation
People prescribed opioids for acute pain are aware of the potential for experiencing physical dependence and symptoms of withdrawal and have a plan for tapering and discontinuation.

Quality Statement 9: Health Care Professional Education
Health care professionals have the knowledge and skills to appropriately assess and treat acute pain using a multimodal approach; appropriately prescribe, monitor, taper, and discontinue opioids; and recognize and treat opioid use disorder.

Resources Quality Statements Advisory Committee About

Acute Pain in People With Opioid Use Disorder

People taking buprenorphine/naloxone or methadone for the treatment of opioid use disorder continue their medication during acute-pain events.

Background

If a person is taking prescribed buprenorphine/naloxone or methadone, whenever possible these medications should be continued during acute-pain events. If acute pain is poorly managed, participation in opioid agonist therapy programs may decrease. Any changes to a care plan for opioid use disorder should be discussed with both the patient and the health care professionals involved in the person’s care. Doses of buprenorphine/naloxone may need to be reduced to treat acute pain with additional opioid therapy. Methadone doses can be divided and given every 8 to 12 hours to provide better acute pain relief. Any changes to opioid agonist therapy doses should be communicated to the original prescriber.

People with past opioid use disorder should discuss their values and preferences for treating acute pain with opioids with their health care professionals. Other non-opioid therapies may be considered as part of a multimodal approach.

Knowledge of effective treatment for acute pain in people with a current substance use disorder is limited and complicated by factors including:

The psychological, social, and behavioural characteristics associated with substance use disorders
The concurrent use of other drugs or alcohol
Medications being used to assist with drug withdrawal and relapse prevention
Complications of drug use including organ impairment and infectious diseases
The increased risk of traumatic injury
The presence of drug tolerance, physical dependence, or withdrawal

Wherever possible, health care professionals should consult with the person’s primary care provider. They may also need to consult with an addictions or pain specialist to coordinate care for people with opioid use disorder who are experiencing acute pain.

What This Quality Statement Means

For Patients

If you take buprenorphine/naloxone or methadone for opioid use disorder (which includes opioid addiction), continue to take this medication during times when you are being treated for acute pain.

For Clinicians

Work with other clinicians to provide effective acute-pain management for people with opioid use disorder while maintaining opioid agonist therapy regimens.

For Health Services

Ensure that people with opioid use disorder have access to continued opioid agonist therapy during acute-pain events. Ensure that structures are in place for health care professionals treating acute pain to communicate with opioid agonist therapy prescribers.

Quality Indicators

Process Indicator

Percentage of people on opioid agonist therapy with acute pain who continue taking opioid agonist therapy

Denominator: total number of people with acute pain who were taking opioid agonist therapy prior to the acute-pain event
Numerator: number of people in the denominator who continue taking opioid agonist therapy during the acute-pain event
Data sources: local data collection or linked administrative databases, including the Narcotics Monitoring System

Definitions Used Within This Quality Statement

Opioid agonist therapy

Opioid agonist therapy is the provision of an opioid agonist (typically a long-acting formulation) as part of a treatment program. Opioid agonist therapy eliminates the cycle of intoxication and withdrawal, reduces opioid cravings, and blocks the effect of other opioids. People with opioid use disorder who are stabilized on opioid agonist therapy are considered to be in recovery and typically experience a significant improvement in health and social function. They would have uncomfortable symptoms if they were suddenly to discontinue opioid agonist therapy, but they are no longer considered to have an active substance use disorder. In Ontario, opioid agonist therapy must be prescribed by a physician or nurse practitioner.

Evidence to Improve Care