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

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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.

Background

When possible, health care professionals should check the prescription history of a person with acute pain before prescribing or dispensing opioids. Prescription history can inform the management of acute pain by identifying past or current exposure to opioids, which may affect opioid tolerance, and by alerting health care professionals to the total morphine equivalents of multiple prescriptions or the increased risks for overdose or death posed by combining opioids with other prescribed controlled substances such as benzodiazepines. The use of prescription monitoring systems also allows health care professionals to identify multiple prescriptions and other behaviours associated with diversion.

What This Quality Statement Means

For Patients

To make sure you receive the safest treatment, your health care professional and pharmacist will check your prescription history before prescribing or giving you opioids. They do this to see if you have recently been given opioids or other medications that are dangerous to take with opioids.

Whenever possible, you should not take opioids and benzodiazepines at the same time. Benzodiazepines include medications like lorazepam, diazepam, and alprazolam. Taking opioids and benzodiazepines together can cause serious breathing problems.

For Clinicians

Check the prescription history of people with acute pain for duplicate prescriptions, potentially harmful medication interactions, and indications of possible diversion behaviour before you prescribe or dispense opioids.

For Health Services

Ensure that opioid prescribers and pharmacists have access to a real-time prescription monitoring system at the point of care.

Quality Indicators

Process Indicator

Percentage of people with acute pain prescribed an opioid whose prescription history was reviewed at the time an opioid was prescribed

Denominator: total number of people with acute pain who were prescribed an opioid
Numerator: number of people in the denominator whose prescription history was reviewed at the time an opioid was prescribed
Data source: local data collection

Structural Indicator

Availability of a prescription monitoring system to provide health care professionals who prescribe or dispense opioids with real-time prescription information at the point of care

Data source: provincial/regional data collection

Definitions Used Within This Quality Statement

Diversion

Diversion is the transfer of prescribed opioids from the person for whom they were prescribed to another person for illicit use.

Prescription monitoring system

A prescription monitoring system is an electronic database that collects information on controlled prescription drugs prescribed by health care professionals and dispensed by pharmacies. In Ontario, the Narcotics Monitoring System (NMS) is the central database available to enable reviews of monitored drug prescribing and dispensing activities and to alert prescribers and pharmacists to potential instances of polypharmacy and double-doctoring.

Evidence to Improve Care