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

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.

Background

Health care professionals should provide patient- and family-centred, individually tailored education, including information on treatment options for the management of acute pain, to allow people with acute pain and their families and caregivers, as appropriate, to participate in shared decision-making. Health care professionals should also document the plan for pain management.

What This Quality Statement Means

For Patients

Your health care professional should discuss the potential benefits and harms of opioid therapy for acute pain with you so that you can make informed decisions about your care together. If you have family or others involved in your care, they should also receive this information. Potential harms of opioid therapy include becoming dependent on the medication, uncomfortable physical symptoms when you stop taking the medication, addiction, and overdose.

For Clinicians

Provide people with acute pain and their families and caregivers with information verbally and via printed or multimedia formats on the potential benefits and harms of opioid therapy in an accessible format.

For Health Services

Ensure that evidence-based, unbiased information is available in a variety of formats for people with acute pain. Provide an environment that allows clinicians to have conversations about various therapy options with people with acute pain, families, and caregivers.

Quality Indicators

Process Indicators

Percentage of people with acute pain prescribed an opioid with documentation of receiving information about the potential benefits and harms of opioid therapy at the time an opioid is prescribed

Denominator: total number of people with acute pain who are prescribed an opioid
Numerator: number of people in the denominator with documentation of receiving information about the potential benefits and harms of opioid therapy (see definition) at the time an opioid is prescribed
Data source: local data collection

Percentage of people with acute pain prescribed an opioid with documentation of receiving information about the potential benefits and harms of opioid therapy at the time an opioid is dispensed

Denominator: total number of people with acute pain who are prescribed an opioid
Numerator: number of people in the denominator with documentation of receiving information about the potential benefits and harms of opioid therapy at the time an opioid is dispensed
Data source: local data collection

Percentage of people with acute pain who are prescribed an opioid and report their health care professional always or often involves them as much as they want in decisions about their care and treatment for acute pain

Denominator: total number of people with acute pain who are prescribed an opioid
Numerator: number of people in the denominator who report that their health care professional always or often involves them as much as they want in decisions about their care and treatment for acute pain
Data source: local data collection
Sample survey question: When you see your care provider or someone else in their office, how often do they involve you as much as you want in decisions about your care and treatment?(Response options: Always, Often, Sometimes, Rarely, Never, It depends on who I see and/or what I am there for, Not using or on any treatments/not applicable, Don’t know, Refused)

Definitions Used Within This Quality Statement

Information

Information should be provided to people with acute pain during in-person visits verbally and via printed or multimedia formats. This information should include, at a minimum, content related to the following:

Pain management:

Goals for pain management
Alternative non-opioid pharmacotherapy and nonpharmacological therapies for acute pain, including their effects, risks, and costs

Opioid prescribing:

Instructions to take prescribed medications only as needed to relieve severe acute pain
The signs and symptoms of physical dependence and withdrawal
A plan for tapering opioids when pain resolves
A plan for when to follow up with a primary care provider if pain does not resolve

Reducing potential harms of opioids:

Associated risk factors for opioid use disorder and for overdose and death (e.g., mental health comorbidities, current or past substance use disorder, co-prescribed central nervous system depressants or other sedative hypnotics)
Possible adverse effects of opioid therapy for acute pain, including the risk of falls, impaired driving, and occupational hazards
How to recognize and respond to an opioid overdose
The risk of short-term opioid use leading to long-term use
The safe storage and disposal of opioids to prevent harms to others and to prevent diversion in the community

Shared decision-making

Shared decision-making is a collaborative process that allows people with acute pain and their health care professionals to make decisions together. The health care professional is responsible for the following:

Inviting the person to participate in the conversation and decision-making
Presenting pain management options
Providing information on the benefits and risks of each pain management option
Helping people evaluate pain management options based on their values and preferences
Facilitating deliberation and decision-making
Helping implement decisions
Offering and incorporating decision-making tools such as decision aids into the shared decision-making process

Evidence to Improve Care