Stepwise Approach for the Prescription of Opiates for Non-Cancer Pain: A Review of Clinical Evidence and Guidelines [Internet]

Excerpt

The terms opiate and opioid are often used interchangeably. Opiates are medications derived from opium poppy such as morphine and codeine, while opioids refer to opium-like substances including endogenous substances such as endorphins, as well as exogenous synthetic drugs that interact with opioid receptors. The generic term “Opioid” (including opiates and opioids) is therefore the preferred term for use throughout this report.

In Canada, the prescription of opioids for pain management increased by about 50% between 2000 and 2004. The increase in prescribing of opioids has been associated with increase in misuse, abuse, diversion, and opioid-related overdoses that are accompanied by increasing emergency department visits, hospitalizations, and deaths. In 2008, the prevalence of any use of opioid pain relievers in general population in Canada was 21.6%. In 2011, the rate was decreased to 16.7%. There was an almost 250% increase in the number of emergency visits in Ontario related to narcotics withdrawal, overdose, intoxication, harmful use and other related diagnoses from 2005–2006 to 2010–2011.

Given the current rate of opioid overdose and harms associated with opioid use, stepwise approaches to prescribing, which progress from non-opioids to weak opioids and finally strong opioids such as hyrdomorphone if pain persists, have been proposed. As such, there is a growing need for clinical evidence and guidance for the use of stepwise approaches for the prescription of opioid for non-cancer pain management in the emergency department and in-hospital setting.