Pain

Opioid Manager Image
The Opioid Manager is a point-of-care tool which distills essential information and advice from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-cancer Pain. This practical tool helps providers initiate and monitor opioid therapy for patients with chronic non-cancer pain.

Question #1: When stopping opioids, the dose should be tapered by 10% of the total daily dose every 1-2 weeks, and then by 5% once one-third of the original dose is achieved.

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Question #2: What is the appropriate first-line opioid selection for severe pain?

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Opioid Manager

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The number of patients with chronic non-cancer pain is significant and growing. It is a particular problem among people:

  • Older than 65
  • Living with  osteoarthritis
  • Coping with neuropathic pain
  • Experiencing low-back pain

Opioids can be an effective way to treat pain but it is important for providers to know how to balance the benefits, risks, and side effects of opioid therapy.

The Centre for Effective Practice, in conjunction with Toronto Rehabilitation Institute and the National Opioid Use Guideline Group (NOUGG), developed a clinical support tool to assist healthcare providers to safely and effectively prescribe opioids for chronic non cancer pain. The Opioid Manager is a point of care tool based on the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non Cancer Pain. It condenses key elements from the Canadian Opioid Guideline and can be used as a chart insert.

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Project Overview

The number of patients with chronic non-cancer pain is significant and growing. Opioids can provide effective treatment for chronic non-cancer (CNCP) pain but it is important for providers to know how to balance the benefits, risks, and side effects of opioid therapy.

In response to concerns from physicians, medical regulatory bodies, patients and the public a National Opioid Use Guideline Group (NOUGG) was formed in 2007. NOUGG was responsible for overseeing the development and implementation of a guideline to assist physicians in managing patients with CNCP by prescribing opioids in a safe and effective manner. The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non Cancer Pain is a national guideline based on the best available evidence and expert opinion consensus. All guidelines provide information and recommendations but in order to change practice, busy providers need useful, easy-to-use tools.

The Centre for Effective Practice, in conjunction with Toronto Rehabilitation Institute and the National Opioid Use Guideline Group (NOUGG) developed a clinical support tool to assist healthcare providers to safely and effectively prescribe opioids for chronic non cancer pain. This clinical support tool is based on the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non Cancer Pain.

Development Process

The Opioid Manager was developed using CEP’s integrated knowledge translation development methods. CEP ensures that health care providers are engaged throughout the tool development process, using a User Centered Design methodology to test the usability of tools from a provider perspective.

Meet the Team

The Opioid Manager was developed with input and review from a clinical lead and partners.

Clinical Lead

Jose Silveira Head Shot

Jose Silveira B.Sc., M.D., FRCPC, Dip. ABAM

Dr. Silveira is an Assistant Professor in the Department of Psychiatry, Faculty of Medicine at the University of Toronto. Dr. Silveira serves as co-chair of the Ontario College of Family Physician’s Collaborative Mentoring Network, which works to increase the capacity of the health care system to treat mental disorders and addictions by supporting primary care providers. He is currently Medical Director of the Mental Health and Addiction Programs and Psychiatrist-in-Chief at St. Joseph’s Health Centre in Toronto. Dr. Silveira’s professional focus has been a systems approach to enhancing the delivery of mental health and addiction care on a population basis through primary care and community networks. Dr. Silveira has presented nationally and internationally on the latter topic.

To learn more about the players involved in developing the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non Cancer Pain see: nationalpaincentre.mcmaster.ca/opioid/cgop_a06_players_involved_in_development.html

Supporting Material

Here are are some additional resources and sources of information. These supporting materials are hosted by external organizations and we cannot guarantee the accuracy and accessibility of their links. CEP will make every effort to keep these links up to date.

The Switching Opioids form is designed to guide the provider in switching from one opioid to another.

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Canada: National Opioid Use Guideline Group (NOUGG); 2010. Available from: http://nationalpaincentre.mcmaster.ca/opioid/

Demonstration Video on how to use the Opioid Manager in practice http://nationalpaincentre.mcmaster.ca/opioidmanager/opioid_manager_video.html

The Opioid Manager is available in a number of EMR platforms. http://nationalpaincentre.mcmaster.ca/opioidmanager/emr_platforms.html

Medical Mentoring for Addictions and Pain (MMAP)

Modeled after the OCFP’s Collaborative Mental Healthcare Network (CMCHN) [see http://www.ocfp.on.ca/cme/cmhcn for further information], the MMAP initiative supports physicians with expertise in pain management and addictions including methadone prescribers to mentor family physicians interested in chronic pain and or addictions. http://ocfp.on.ca/cpd/collaborative-networks/mmap

Copyright & Disclaimer

CEP fully supports the use of The Opioid Manager and Switching Opioids Form by providers, educators, decision-makers and others. Please read the following information prior to use of the Tool to ensure appropriate permission is sought and appropriate citation is used.

Creative Commons License

Creative Commons The Opioid Manager and Switching Opioids Form are products of the Centre for Effective Practice. Permission to use, copy and distribute this material for all non-commercial and research purposes is granted, provided that all copies, modifications, and distributions contain full reproductions of this Creative Commons License and the following Disclaimer along with appropriate citations. Use of The Opioid Manager and Switching Opioids Forms for commercial purposes or any modifications of the tools are subject to charge and use must be negotiated with Centre for Effective Practice (Email: info@effectivepractice.org).

For statistical and bibliographic purposes, please notify the Centre for Effective Practice (info@effectivepractice.org) of any use or reprinting of the tools.

Please use this citation when referencing the tool:

Reprinted with Permission from Centre for Effective Practice (2011). The Opioid Manager. Toronto: Centre for Effective Practice.

Reprinted with Permission from Centre for Effective Practice (2011). Switching Opioids Form. Toronto: Centre for Effective Practice

Disclaimer

The Opioid Manager (the “Tool”) contains links to websites and other external resources (“Third Party Resources”) that are operated by and/or created by third party organizations. These third party organizations are solely responsible for the information contained in, and the operation of (as applicable), their respective Third Party Resource(s).

This Tool was developed for licensed health care professionals in Ontario as a guide only and does not constitute medical or other professional advice. Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this Tool.

Neither the Centre for Effective Practice (“CEP”), Toronto Rehabilitation Institute, National Opioid Use Guideline Group (NOUGG), Government of Ontario, the contributors to this Tool, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this Tool; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this Tool by any individual including, but not limited to, primary care providers, or entity, including for any loss, damage or injury (including death) arising from or in connection with the use of this Tool, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any of the Third Party Resources, that are owned or operated by third parties, including any information or advice contained therein.