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Pain Research and Management
Volume 18, Issue 4, Pages 177-184
Original Article

Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians

Michael JM Allen,1 Mark M Asbridge,2,3 Peter C MacDougall,4 Andrea D Furlan,5,6 and Oleg Tugalev7

1Continuing Medical Education, Halifax, Nova Scotia, Canada
2Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada
3Department of Emergency Medicine, Halifax, Nova Scotia, Canada
4Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
5Institute for Work and Health, Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
6Department of Medicine, University of Toronto, Toronto, Canada
7Rehabilitation Services, Woodstock General Hospital, Woodstock, Ontario, Canada

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians’ (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated.

OBJECTIVES: To determine FPs’ practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP.

METHODS: An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges.

RESULTS: A total of 710 responses were received. FPs followed a precautionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug-related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the ‘watchful dose’ of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient’s opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse.

CONCLUSIONS: While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs.