At its May 27th meeting, the College Council endorsed the US Centers for Disease Control and Prevention’s (CDC) Guidelines for Prescribing Opioids for Chronic Pain as best practices for physicians in Nova Scotia.
“We recognize these guidelines represent a significant departure from present practice for many physicians,” said Dr. Gus Grant, Registrar and CEO of the College of Physicians and Surgeons of Nova Scotia.
“The existing threshold dose is 200 milligrams per day of morphine. The CDC guidelines urge caution at doses of 50 milligrams and to avoid doses in excess of 90 milligrams. In essence, this represents a dramatic change, a dramatic reduction in acceptable dosages for chronic non-cancer pain,” said Dr. Grant.
Among the CDC’s 12 recommendations is the promotion of non-pharmacologic and non-opioid therapies as preferred treatments of chronic pain. If a risk-benefit analysis indicates that opioid therapy is appropriate, physicians are advised to prescribe the lowest effective dosage with ongoing reassessment of the patient. Physicians are also cautioned to avoid prescribing opioid pain medication and benzodiazepines concurrently.
“The implementation of these new guidelines into a physician’s practice will take time. The College recognizes there will be challenges particularly with tapering dosages of long standing patients. The CDC guidelines, however, are built on a firm foundation of evidence that weighs the benefits of these medications as against the risks,” said Dr. Grant.
The College previously endorsed the Canadian guideline developed by the National Pain Centre at McMaster University. This guideline, published in 2006 is now under revision and the College looks forward to reviewing the refreshed version upon its completion.