Opioid Manager

Opioid Manager Image
In Ontario alone, one in eight people received an opioid for chronic non-cancer pain in 2016. The Opioid Manager is a clinical tool designed to support primary care providers manage opioid prescriptions for patients across Canada who experience chronic non-cancer pain.

Question #1: Which of the following opioids is not recommended for initiating a trial of opioid therapy?

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Question #2: Fatal and non-fatal opioid overdose risk is significant even at doses <20 mg morphine equivalents daily.

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Tool

Opioid Manager
Opioid_Chart_Feb_2011_B_4-1
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The Opioid Manager is designed to support health care providers prescribe and manage opioids for patients with chronic non-cancer pain.

The Centre for Effective Practice, in conjunction with the University Health Network, have updated the Opioid Manager tool based on feedback from health care providers and the recommendations from the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.

What’s new with the Opioid Manager 2017?

The new Opioid Manager:

  • Emphasizes the importance of optimizing non-pharmacological and non-opioid pharmacotherapy interventions.
  • Contains initial dosing, titration and morphine equivalency information for all recommended opioids.
  • Contains succinct information and examples on how to appropriately monitor, taper and switch opioid prescriptions.
  • Includes accompanying fillable appendices that can inserted into the patient medical chart.
  • Opioids can be an effective way to treat pain, but it is important for providers to know how to balance the risks and side effects of opioid therapy with the desired benefits.

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    Project Overview

    Development Process

    The Opioid Manager was developed using the Centre for Effective Practice integrated knowledge translation approach. This approach ensures that providers are engaged throughout the development processes through the application of user-centered design methodology. Clinical leadership for the Opioid Manager was provided by Drs. Andrea Furlan, Arun Radhakrishnan and Jose Silveira. End-users and clinical experts were also engaged to provide feedback on the Opioid Manager content.

    The Opioid Manager is based on the 2017 Canadian Guideline for Opioids for Chronic Pain.

    Meet the Team

    The Centre for Effective Practice enlisted the collaboration of the following clinical leadership throughout the development of the Opioid Manager.

    Clinical Lead

    Dr. Arun Radhakrishnan MSc, MD, CM CCFP

    Dr. Arun Radhakrishnan is a family physician with a focused practice in chronic pain and is the current co-chair of the Collaborative Mental Health Network and the Medical Mentoring for Addictions and Pain Network at the Ontario College of Family Physicians. He is also an adjunct assistant professor with the Department of Family and Community Medicine at the University of Toronto.

    In 2013 Dr. Radhakrishnan completed a Master’s degree at the University of Toronto in Health Services Research focusing on the value of information and communication technologies to enable knowledge translation activities in the areas of pain, mental health and addictions to support community physicians. His interests also include teaching and curriculum development around the integration of technology into the clinical encounter.

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

    Dr. Jose Silveira is an Associate Professor in the Department of Psychiatry, Faculty of Medicine at the University of Toronto. Since 2001, Dr. Silveira has worked closely with the Ontario College of Family Physician’s Collaborative Mentoring Networks on the steering committee, as co-chair and as mentor. The networks support primary care providers in managing mental disorders, addictions and chronic pain. In 2016, the Ontario College of Family Physicians recognized Dr. Silveira for many years of service to the Mentoring Networks. Dr. Silveira’s professional focus is to support the delivery of mental health and addiction care through primary care and community networks.

    Andrea FurlanAndrea Furlan MD, PhD
    Dr. Andrea Furlan is an Associate Professor in the Department of Medicine at the University of Toronto and a Staff Physician and Senior Scientist at the Toronto Rehabilitation Institute. She is also a Scientist at the Institute for Work & Health in Toronto. She obtained her PhD in Clinical Epidemiology from the Institute of Health Policy, Management and Evaluation at the University of Toronto. Dr. Furlan has extensive experience in reviewing the scientific literature for the Cochrane Collaboration and for clinical practice guidelines. She received a CIHR New Investigator Award, and her research focus is on treatments of chronic pain including medications, complementary and alternative therapies, and rehabilitation. She was the team leader for the development of the Canadian Opioid Guideline, and is now involved with Guideline’s National Faculty in the dissemination and implementation of the guideline across Canada. She provided clinical leadership for the original and updated Opioid Manager. She is the author of the My Opioid Manager, a book and App for patients using opioids for chronic pain. Dr. Furlan is a co-Chair of Echo Ontario (link is external) for Pain and Opioid Stewardship.

    Target End User & Expert Opinion

    The Centre for Effective Practice also sought target end user and expert input to inform the content of the Opioid Manager. We are grateful to these individuals for their time and expertise.

    Supporting Material

    Listed below 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.

    Supporting Material

    1. Management of Chronic Non-Cancer Pain – Appendices
      https://thewellhealth.ca/cncp
    2. Management of Chronic Non-Cancer Pain
      https://thewellhealth.ca/cncp
    3. Opioid Medication Treatment Agreement
      http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b05.html
    4. Brief Pain Inventory (BPI)
      http://nationalpaincentre.mcmaster.ca/documents/brief_pain_inventory.pdf
    5. Opioid Tapering – Information for Patients
      http://nationalpaincentre.mcmaster.ca/documents/Opioid%20Tapering%20Patient%20Information%20(english).pdf
    6. Opioid Tapering Template
      http://www.rxfiles.ca/rxfiles/uploads/documents/Opioid-Taper-Template.pdf
    7. FAQ About Prescribing Buprenorphine
      https://www.cpso.on.ca/CPSO/media/documents/Methadone/FAQs-Prescribing-Buprenorphine.pdf

    References

    1. Michael G. DeGroote National Pain Centre, McMaster University. Canadian guideline for safe and effective use of opioids for chronic non-cancer pain. 2017; [cited Sept 5, 2017]. Available from: http://nationalpaincentre.mcmaster.ca/opioid/
    2. Centre for Effective Practice. Management of chronic non cancer pain (Appendix). 2017; [cited Sept 27, 2017]. Available from: https://thewellhealth.ca/wp-content/uploads/2017/03/CEP_CNCP_Appendix_V1.pdf
    3. Canadian Pharmacists Association. Compendium of pharmaceuticals and specialties. 2017; [cited Sept 5, 2017]. Available from: https://www.pharmacists.ca/
    4. Mercadante S, Porzio G, Fulfaro F, Aielli F, Verna L, Ficorella C, et al. Switching from transdermal drugs: an observational “N of 1” study of fentanyl and buprenorphine. J Pain Symptom Manage 2007;34:5328.
    5. Sittl R, Likar R, Nautrup BP. Equipotent doses of transdermal fentanyl and transdermal buprenorphine in patients with cancer and noncancer pain: results of a prospective cohort study. Clin Ther. 2005;27:225–37.
    6. Canadian Pharmacists Association. Compendium of pharmaceuticals and specialties. 2008; [cited Sept 21, 2017].
    7. Passik SD, Kirsh KL, Whitcomb L, Dickerson PK, Theobald DE. Pain clinicians’ rankings of aberrant drugtaking behaviors. J Pain Palliat Care Pharmacother. 2002;16(4):39–49.

    Copyright & Disclaimer

    The CEP fully supports the use of The Opioid Manager 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.

    The Opioid Manager was developed by the Centre for Effective Practice (“CEP”) with clinical leadership from Drs. Andrea Furlan, Arun Radhakrishnan and Jose Silveira. In addition, the Opioid Manager was informed by advice from target end-users engaged throughout the development process. The Opioid Manager was updated with funding from the University Health Network (“UHN”).

    Creative Commons License

    Creative Commons The Opioid Manager is a product of the CEP and UHN under copyright protection with all rights reserved to UHN. Permission to use, copy, and distribute printed copies of the Opioid Manager and permission to link to a author webpage for the Opioid Manager, for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and appropriate citations appear in all copies, modifications, and distributions. Republishing digital materials via third-party websites or platforms is prohibited. Use of the Opioid Manager for commercial purposes or any modifications of the Opioid Manager are subject to charge and use must be negotiated with the CEP and UHN (Email: [email protected]).

    For statistical and bibliographic purposes, please notify the CEP ([email protected]) of any use or reprinting of the Opioid Manager. Please use the below citation when referencing the Opioid Manager:

    Reprinted with Permission from the Centre for Effective Practice and University Health Network (October 2017). Opioid Manager. Toronto.

    Disclaimer

    The Opioid Manager was developed for licensed health care professionals in Canada 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 the Opioid Manager. Neither the CEP, UHN, the contributors to the Opioid Manager, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through the Opioid Manager; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of the Opioid Manager 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 the Opioid Manager, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any external sources referenced in the Opioid Manager (whether specifically named or not) that are owned or operated by third parties, including any information or advice contained therein.

    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).