Health Quality Ontario’s Opioid Prescribing for Chronic Pain Quality Standard provides guidance on the prescribing, monitoring, and tapering of opioids to treat chronic pain for people 15 years of age and older in all care settings.
The quality standard includes 10 quality statements addressing areas that have high potential for improving the quality of care in Ontario for people with chronic pain who have been prescribed or are considering opioids.
Below is a sample of tools that may help you with the implementation of the quality statements into practice.
This list is not exhaustive. Are there other tools or resources you use? Do you have experience implementing these tools? If so, please use the comments section below to share!
Comprehensive resources related to opioid prescribing for chronic pain
The Management of Chronic Non-Cancer Pain Tool and Appendix by the Centre for Effective Practice can guide selection of non-pharmacological and/or non-opioid therapies.
McMaster University National Pain Centre 2017 Guideline for Opioids for Chronic Non-Cancer Pain provides recommendations for clinical practice.
Resources per quality statement
1. Comprehensive Assessment: People with chronic pain receive a comprehensive assessment, including consideration of their functional status and social determinants of health.
The quality standard lists nine elements that should be included in a comprehensive assessment for patients with chronic pain.
The following tools may be helpful in conducting these comprehensive assessments:
2. Setting Goals for Pain Management and Function: People with chronic pain set goals for pain management and functional improvement in partnership with their health care professionals. These goals are evaluated regularly
3. First-Line Treatment With Non-opioid Therapies: People with chronic pain receive an individualized and multidisciplinary approach to their care. They are offered non-opioid pharmacotherapy and nonpharmacological therapies as first-line treatment.
4. Shared Decision-Making and Information on the Potential Benefits and Harms of Opioids for Chronic Pain: People with chronic pain, and their families and caregivers, receive information about the potential benefits and harms of opioid therapy for chronic pain at the time of both prescribing and dispensing so that they can participate in shared decision-making.
5. Initiating a Trial of Opioids for Chronic Pain: People with chronic pain begin a trial of opioid therapy only after other multimodal therapies have been tried without adequate improvement in pain and function, and they either have no contraindications to opioid therapy or have discussed any relative contraindications with their health care professional.
- The Opioid Manager by the Centre for Effective Practice is intended to support health care providers prescribe and manage opioids for patients with chronic non-cancer pain and includes important considerations for opioid therapy trials and starting an opioid trial
- Appendix A of the Opioid Manager includes a checklist that can be completed and inserted into the patient medical record for starting or continuing a trial of opioids
6. Co-prescribing Opioids and Benzodiazepines: People with chronic pain are not prescribed opioids and benzodiazepines at the same time whenever possible.
7. Opioid Use Disorder: People prescribed opioids for chronic pain who are subsequently diagnosed with opioid use disorder have access to opioid agonist therapy.
8. 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 and every 3 to 6 months during long-term use, or more frequently if there are concerns regarding duplicate prescriptions, potentially harmful medication interactions, or diversion.
- The Digital Health Drug Repository by eHealth Ontario allows health care professionals to access patients’ clinically relevant drug and pharmacy service information to assist with medication reviews
9. Tapering and Discontinuation: All people with chronic pain on long-term opioid therapy, especially those taking 90 mg morphine equivalents or more per day, are periodically offered a trial of tapering to a lower dose or tapering to discontinuation.
- The Opioid Tapering Template by the Centre for Effective Practice can guide health care professionals to evaluate opioid therapies and reduce opioid dosages in safe and effective ways
- The Safer Opioid Prescribing Strategies course through Machealth teaches health care professionals strategies for when and how to taper and switch opioids
10. Health Care Professional Education: Health care professionals have the knowledge and skills to appropriately assess and treat chronic pain using a multidisciplinary, multimodal approach; appropriately prescribe, monitor, taper, and discontinue opioids; and recognize and treat opioid use disorder.
The Ontario Pain Management Resources websiteby Health Quality Ontario includes an up-to-date list of many educational resources specific to chronic pain.
Here are a few key educational opportunities from this list:
- The Centre for Effective Practice provides one-on-one education outreach visits with a local academic detailer to help health care professionals stay up to date on the latest clinical evidence on a number of opioid-related topics.
- Medical Mentoring for Addictions and Pain provided by the Ontario College of Family Physicians connects family physicians with experts in pain and addictions to help manage patients’ pain, addictions and the challenges around opioid prescribing
Health Quality Ontario’s related Quality Standards on opioid prescribing for acute pain and opioid use disorder may also be useful.
Health Quality Ontario’s Ontario Pain Management Resources website provides an up-to-date list of tools from partner organizations across the province.
Comment below to describe your experience with these tools or share any others you have found useful!
This post is part of a series about how quality standards can be used to support quality improvement together with others who are working on adopting the quality standards. The introductory post can be found here.