McMaster University

Michael G. DeGroote
National Pain Centre

Scope of Search

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

Cluster 1: Deciding to Initiate Opioid Therapy

Summary of Recommendations

No. Recommendation Keyword
R01 Before initiating opioid therapy, ensure comprehensive documentation of the patient’s pain condition, general medical condition and psychosocial history (Grade C), psychiatric status, and substance use history. (Grade B). Comprehensive assessment
R02 Before initiating opioid therapy, consider using a screening tool to determine the patient’s risk for opioid addiction. (Grade B). Addiction-risk screening
R03 When using urine drug screening (UDS) to establish a baseline measure of risk or to monitor compliance, be aware of benefits and limitations, appropriate test ordering and interpretation, and have a plan to use results. (Grade C). Urine drug screening
R04 Before initiating opioid therapy, consider the evidence related to effectiveness in patients with chronic non-cancer pain. (Grade A). Opioid efficacy
R05 Before initiating opioid therapy, ensure informed consent by explaining potential benefits, adverse effects, complications and risks (Grade B). A treatment agreement may be helpful, particularly for patients not well known to the physician or at higher risk for opioid misuse. (Grade C). Risks, adverse effects, complications
R06 For patients taking benzodiazepines, particularly for elderly patients, consider a trial of tapering (Grade B). If a trial of tapering is not indicated or is unsuccessful, opioids should be titrated more slowly and at lower doses. (Grade C). Benzodiazepine tapering