Cited by 707Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

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Guideline for opioid therapy and chronic noncancer pain

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Busse, Jason W., Craigie, Samantha, Juurlink, David N., Buckley, D. Norman, Wang, Li, Couban, Rachel J., Agoritsas, Thomas, Akl, Elie A., Carrasco-Labra, Alonso, Cooper, Lynn, Cull, Chris, da Costa, Bruno R., Frank, Joseph W., Grant, Gus, Iorio, Alfonso, Persaud, Navindra, Stern, Sol, Tugwell, Peter, Vandvik, Per Olav, Guyatt, Gordon H.·2017·Canadian Medical Association Journal

DOI 10.1503/cmaj.170363PMC PMC5422149

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Abstract

Chronic noncancer pain includes any painful condition that persists for at least three months and is not associated with malignant disease.[1][1] According to seven national surveys conducted between 1994 and 2008, 15%–19% of Canadian adults live with chronic noncancer pain.[2][2] Chronic

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GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
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Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians
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“included ramp intervention functions in all models to account for slope trends in rates of naloxone dispensing before and after the program changes and changes in naloxone dispensing associated with the May 2017 publication of Canadian guidelines for the use of opioids in chronic non-cancer pain, which supported the p…”
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Martel, M. O., Bruneau, A., & Edwards, R. R. (2021) · Translational research · doi:10.1016/j.trsl.2021.02.013 · Cited by 16
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‘Delisting’ OxyContin® to reduce prescription opioid‐related harms in Ontario (Canada)—gauging effects 5 years later
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Healthcare provider knowledge, attitudes, beliefs, and practices surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review
Rash, J. A., Buckley, N., Busse, J. W., Campbell, T. S., Corace, K., Cooper, L., Flusk, D., Iorio, A., Lavoie, K., Poulin, P. A., et al. (2018) · Systematic Reviews · doi:10.1186/s13643-018-0858-7 · Cited by 14
“Clinical practice guidelines (CPGs) have been developed by several countries, including the USA [35] and Canada [2], to support evidence-based prescription of opioid medication for the management of chronic non-cancer pain.”
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Efficacy and safety of controlled-release oxycodone for the management of moderate-to-severe chronic low back pain in Japan: results of an enriched enrollment randomized withdrawal study followed by an open-label extension study
Kawamata, M., Iseki, M., Kawakami, M., Yabuki, S., Sasaki, T., Ishida, M., Nishiyori, A., Hida, H., & Kikuchi, S. (2019) · Journal of Pain Research · doi:10.2147/jpr.s179110 · Cited by 13
“However, given the limited number of patients and the inherent potential for drug dependency, we advise careful patient selection, periodic monitoring, and risk assessment for drug dependence in patients treated with opioids to limit the risk for abuse and overdose.(16,17) Unlike Western countries, Japan has a low inc…”
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A retrospective quantitative implementation evaluation of Safer Opioid Prescribing, a Canadian continuing education program
Sud, A., Doukas, K., Hodgson, K., Hsu, J., Miatello, A., Moineddin, R., & Paton, M. (2021) · BMC Medical Education · doi:10.1186/s12909-021-02529-7 · Cited by 14
Opioid initiation and the hazard of falls or fractures among older adults with varying levels of central nervous system depressant burden
Guan, Q., Men, S., Juurlink, D. N., Bronskill, S. E., Wunsch, H., & Gomes, T. (2022) · Drugs & Aging · doi:10.1007/s40266-022-00970-x · Cited by 12
“Central nervous system (CNS) depressants (including opioids, antidepressants, antipsychotics, benzodiazepines, and anticonvulsants) alter neuronal activity and are used for a wide range of therapeutic indications including pain, seizures, anxiety, depression, sleep disorders, schizophrenia, and other disorders [1, 2].”
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Inequities in access to primary care among opioid recipients in Ontario, Canada: A population-based cohort study
Gomes, T., Campbell, T. J., Martins, D., Paterson, J. M., Robertson, L., Juurlink, D. N., Mamdani, M., & Glazier, R. H. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003631 · Cited by 15
“There is particular concern that this has been exacerbated in recent years with the publication of clinical guidelines for opioid prescribing in chronic non-cancer pain [16,17] that recommended changes in opioid prescribing patterns across North America, sometimes straining the patient–physician relationship [11,18,19…”
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Prescription opioids among older adults: ten years of data across five countries
Hamina, A., Muller, A. E., Clausen, T., Skurtveit, S. O., Hesse, M., Tjagvad, C., Thylstrup, B., Odsbu, I., Zoëga, H., Jónsdóttir, H. L., et al. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03125-0 · Cited by 15
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Emary, P. C., Brown, A. L., Oremus, M., Mbuagbaw, L. C. E., Cameron, D. F., DiDonato, J., & Busse, J. W. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08632-9 · Cited by 13
“As we were interested in patients receiving long-term opioid therapy [13], we excluded individuals who had been prescribed opioids for < 90 days at their index visit, or who did not receive any opioid fills or refills after their index visit.”
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Shields, C. G., Fuzzell, L. N., Christ, S. L., & Matthias, M. S. (2018) · Patient Education and Counseling · doi:10.1016/j.pec.2018.12.005 · Cited by 13
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Martins, D., Khuu, W., Tadrous, M., Juurlink, D. N., Mamdani, M., Paterson, J. M., & Gomes, T. (2019) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4764 · Cited by 13
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Jivraj, N. K., Ladha, K. S., Goel, A., Hill, A. D., Wijeysundera, D. N., Bateman, B. T., & Wunsch, H. (2022) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-022-02266-5 · Cited by 13
“Additionally, national opioid-prescribing guidelines aimed at nonsurgical patients have been developed that focus on opioid prescribing in outpatient settings.(11,12) While there is evidence of a recent decline in the rate of individuals prescribed opioids in the general population,(2,13) and in selected USA surgical…”
BackgroundMethod
Studying Drug Safety in the Real World
Zipursky, J. S., & Juurlink, D. N. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.5766 · Cited by 13
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“The recommendation by the 2017 Canadian guideline for chronic non-cancer pain (12) to postpone opioid therapy until psychiatric conditions are stabilized could have unforeseen negative effects in cancer patients in the palliative care setting, who already have a higher prevalence of some mental health disorders (13).”
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Impact of pharmacist-led medication assessments on opioid utilization
Bhimji, H., Landry, E., & Jorgenson, D. J. (2020) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/1715163520908285 · Cited by 13
“In an effort to reduce opioid-related harm, the Canadian Guideline for Opioids in Chronic Non-Cancer Pain recommends that health professionals meet regularly with patients who are prescribed chronic opioids to develop treatment plans to taper opioid doses, maximize use of nonopioid pain medications, provide education…”
BackgroundMethodInfluential
Factors associated with potentially inappropriate opioid use in community‐living older adults consulting in primary care
D’Aiuto, C., Lunghi, C., Guénette, L., Berbiche, D., Pitrou, I., Bertrand, K., & Vasiliadis, H. (2022) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5780 · Cited by 12
“Much of this pain is treated with opioids despite Canadian guidelines recommending non‐opioid and non‐pharmacologic alternatives prior to opioid initiation in chronic non‐cancer pain.(4,5) Multimorbidity in primary care older adults has been associated with high rates of polypharmacy.”
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Association of obstructive sleep apnea and opioids use on adverse health outcomes: A population study of health administrative data
Kendzerska, T., Gomes, T., Malhotra, A., Gershon, A. S., Povitz, M., McIsaac, D. I., Aaron, S. D., Chung, F. F., Bryson, G. L., Talarico, R., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269112 · Cited by 12
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9. Chronic knee pain
Vanneste, T., Belba, A. G., Oei, G. T. M. L., Emans, P. J., Fonkoué, L., Kallewaard, J. W., Kapural, L., Peng, P., Sommer, M., Vanneste, B., et al. (2024) · Pain Practice · doi:10.1111/papr.13408 · Cited by 12
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Canadian clinical practice guidelines for the use of plant-based cannabis and cannabinoid-based products in the management of chronic non-cancer pain and co-occurring conditions: protocol for a systematic literature review
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Retracted
Opioid prescribing and dispensing: Experiences and perspectives from a survey of community pharmacists practising in the province of Quebec
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The authors respond to “Inconsistencies in the 2017 Canadian Guideline for Opioids for Chronic Noncancer Pain”
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Self-citation
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Iacono, A., Campitelli, M. A., Bronskill, S. E., Hogan, D. B., Iaboni, A., Maclagan, L. C., Gomes, T., Tadrous, M., Evans, C. D., Gruneir, A., et al. (2022) · Drugs & Aging · doi:10.1007/s40266-022-00972-9 · Cited by 11
“It is also possible that heightened concern and oversight of opioid prescribing in the community [25] is contributing to a reduced prevalence of opioid use among those entering LTC more recently [17].”
Background
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Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training
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Doctor shopping among chronic noncancer pain patients treated with opioids in the province of Quebec (Canada): incidence, risk factors, and association with the occurrence of opioid overdoses
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“This is consistent with the fact that past substance use disorder is known to be a strong predictor of opioid use disorder.(7)We also found that history of anxiety disorder was a significant predictor of opioid doctor shopping.”
Background
Provider knowledge, beliefs, and self‐efficacy to deprescribe opioids and sedative‐hypnotics
Gray, S. L., Fornaro, R., Turner, J. P., Boudreau, D. M., Wellman, R., Tannenbaum, C., Marcum, Z. A., Balderson, B. H. K., Cook, A. J., Jacobsen, A. L., et al. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18202 · Cited by 11
“, cognitive-behavioral therapy for insomnia).(25,26) Continuing education training that targets writing tapering protocols, formulating and documenting monitoring plans, and highlighting readily available, nonpharmacologic strategies may be one strategy to increase self-efficacy for these aspects of deprescribing.”
Background
Chronic noncancer pain management
Assefa, M., LeClerc, I., Muggah, E., Deonandan, R., Godbout, C., & Finestone, H. M. (2023) · Canadian Family Physician · doi:10.46747/cfp.6903e52 · Cited by 12
Adverse outcomes associated with opioid prescription for acute low back pain: a systematic review protocol
Mouravska, N., Zielinski, L., Bhatt, M., Sanger, N., Bawor, M., Dennis, B. B., Banfield, L. E., MacKillop, J. M., Paul, J., Worster, A., et al. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0556-x · Cited by 11
An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey
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Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007–2016
Jones, W. R., Kurdyak, P. A., & Fischer, B. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05530-w · Cited by 11
Safe opioid prescribing: a prognostic machine learning approach to predicting 30-day risk after an opioid dispensation in Alberta, Canada
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Association of Chiropractic Care With Receiving an Opioid Prescription for Noncancer Spinal Pain Within a Canadian Community Health Center: A Mixed Methods Analysis
Emary, P. C., Brown, A. L., Oremus, M., Mbuagbaw, L. C. E., Cameron, D. F., DiDonato, J., & Busse, J. W. (2022) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2022.06.009 · Cited by 11
Self-citation
Frequency and characteristics of patient exclusion criteria in Canadian multidisciplinary pain treatment facilities: a cross-sectional study
Dassieu, L., Choinière, M., Saint-Jean, L., Webster, F., Peng, P., Buckley, N., Gilron, I., Williamson, O. D., Finley, G. A., Baerg, K., et al. (2022) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-022-02241-0 · Cited by 10
The World Mental Health International College Student Survey in Canada: Protocol for a Mental Health and Substance Use Trend Study
Jones, L., Judkowicz, C., Hudec, K. L., Munthali, R. J., Prescivalli, A. P., Wang, A. Y., Munro, L., Xie, H. W., Pendakur, K., Rush, B. R., et al. (2022) · JMIR Research Protocols · doi:10.2196/35168 · Cited by 10
“Additional questions regarding opioid use were also added to obtain information about adherence to the Canadian Opioid Prescribing Guidelines [24].”
Method
Long‐term opioid treatment and endocrine measures in chronic non‐cancer pain patients
Diasso, P. D. K., Abou‐Kassem, D., Nielsen, S. D., Main, K. M., Sjøgren, P., & Kurita, G. P. (2023) · European Journal of Pain · doi:10.1002/ejp.2136 · Cited by 10
Cognitive Function During Opioid Tapering in Patients with Chronic Pain: A Prospective Cohort Study
Laigaard, J., Bache, N. J., Stottmeier, S., Mathiesen, O., & Estrup, S. (2020) · Journal of Pain Research · doi:10.2147/jpr.s273025 · Cited by 10
Impact of CYP2D6 genotype on opioid use disorder deprescription: an observational prospective study in chronic pain with sex-differences
Muriel, J., Barrachina, J., Barco, G. D., Carvajal, C., Escorial, M., Margarit, C., Ballester, P., & Peiró, A. M. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1200430 · Cited by 10
“Current recommendations warn about a significant increase in OUD risk when the MEDD exceeds 90 mg/day (Busse et al., 2017; Webster, 2017).”
Background
Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia
Lalic, S., Gisev, N., Bell, J. S., & Ilomäki, J. (2019) · Addiction · doi:10.1111/add.14926 · Cited by 10
Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis
Sanger, N., Bhatt, M., Singhal, N., Panesar, B., D’Elia, A., Trottier, M., Shahid, H., Hillmer, A., Baptist-Mohseni, N., Roczyki, V., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00812 · Cited by 10
“chronic, non-cancer pain, acute pain conditions, and prescription monitoring programs (42, 67).”
Background
Guidelines that use the GRADE approach often fail to provide complete economic information for recommendations: A systematic survey
Riva, J. J., Bhatt, M., Brunarski, D. J., Busse, J. W., Martins, C. C., Xie, F., Schünemann, H. J., & Brożek, J. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.04.018 · Cited by 10
Self-citation
Time series-based bibliometric analysis of a systematic review of multidisciplinary care for opioid dose reduction: exploring the origins of the North American opioid crisis
Sud, A., Cheng, D. K.-Y., Moineddin, R., Zlahtic, E., & Upshur, R. E. G. (2021) · Scientometrics · doi:10.1007/s11192-021-04154-z · Cited by 10
“One of their 10 recommendations stated, “For patients with chronic noncancer pain who are using opioids and experiencing serious challenges in tapering, we recommend a formal multidisciplinary program” (Busse et al., 2017).”
Background
A pharmacist-led intervention to improve the management of opioids in a general practice: a qualitative evaluation of participant interviews
Jordan, M., Young-Whitford, M., Mullan, J., Stewart, A. F., & Chen, T. F. (2021) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-021-01340-0 · Cited by 10
“Evidence [25] and guidelines [22, 79] support interdisciplinary management for patients prescribed long-term opioids, yet with erratic integration of pharmacists into general practice internationally, this is not routinely possible.”
Background
Opioid prescribing and utilization patterns in patients having elective hip and knee arthroplasty: association between prescription patterns and opioid consumption
Chan, B., Ward, S. E., Abdallah, F. W., Jones, C., Papachristos, A., Chin, K., Ladha, K. S., & Hare, G. M. T. (2021) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-021-02145-5 · Cited by 10
“Opioid use was converted to MMEs using standard opioid conversion ratios as published in Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.(8) Postoperative opioid prescription characteristics including type, dose, and quantity of medication prescribed were abstracted from the electr…”
Method
Predictors of long-term use of prescription opioids in the community-dwelling population of adults without a cancer diagnosis: a retrospective cohort study
Béliveau, A., Castilloux, A., Tannenbaum, C., Vincent, P. D., de Moura, C. S., Bernatsky, S., & Moride, Y. (2021) · CMAJ Open · doi:10.9778/cmajo.20200076 · Cited by 10
“Using established conversion factors (Table 1), 10,25,34,35 we converted the initial daily dose prescribed into daily morphine milligram equivalents (MME/d), 12,26,35 categorized as follows: 30, 30 to 50, 50 to 90, and ≥ 90 MME/day.”
Opioid Prescribing in Canada following the Legalization of Cannabis: A Clinical and Economic Time-Series Analysis
Dranitsaris, G., DeAngelis, C., Pearson, B., McDermott, L., & Pohlmann-Eden, B. (2021) · Applied Health Economics and Health Policy · doi:10.1007/s40258-021-00638-4 · Cited by 10
Long-term opioid therapy and mental health comorbidity in patients with chronic pain
Vogt, S., Pfau, G., Vielhaber, S., Haghikia, A., Hachenberg, T., & Brinkers, M. (2023) · Pain Medicine · doi:10.1093/pm/pnad004 · Cited by 9
Addiction stigma and opioid use in chronic non‐cancer pain management in Nigeria
Nelson, E.-U. E. (2023) · Sociology of Health & Illness · doi:10.1111/1467-9566.13718 · Cited by 9
Comparative risk of mortality in new users of prescription opioids for noncancer pain: results from the International Pharmacosurveillance Study
Jani, M., Girard, N., Bates, D. W., Buckeridge, D. L., Dixon, W. G., & Tamblyn, R. M. (2024) · Pain · doi:10.1097/j.pain.0000000000003446 · Cited by 10
“…work are consistent with the US Centers for Disease Control and Prevention 2022 recommendations 6 and Canadian recommendations for noncancer pain, 1 which highlight that opioid prescribers should carefully reassess individual benefits and risks of escalating doses beyond 50 MME/day as they are…”
Impact of Dexmedetomidine-Based Opioid-Sparing Anesthesia on Opioid Use After Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Trial
Kim, M.-J., Huh, J., Choi, H., & Hwang, W. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13237264 · Cited by 9
Regular use of opioids and dementia, cognitive measures, and neuroimaging outcomes among UK Biobank participants with chronic non‐cancer pain
Lin, T.-F., Barash, J. A., Wang, S., Li, F.-X., Yang, Z., Kofke, W. A., Sha, F., & Tang, J.-L. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.70177 · Cited by 11
“4,5 Chronic non-cancer pain (CNCP) is defined as any painful condition that persists for more than 3 months and is not associated with malignant disease, 6,7 affecting about 30% of the global population.”
Impact of the Opioid Epidemic and Associated Prescribing Restrictions on People Who Live With Chronic Noncancer Pain in Canada
Kaboré, J., Pagé, M. G., Martel, M. O., Dassieu, L., Hudspith, M., Moor, G., Sutton, K., Roy, J., Williamson, O. D., & Choinière, M. (2021) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000951 · Cited by 9
Medical cannabis and cannabinoids for chronic pain: Summary of a Rapid Recommendation
Busse, J. W., & MacKillop, J. M. (2021) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh-2021-0056 · Cited by 9
Self-citation
Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research
Bell, L. V., Fitzgerald, S. F., Flusk, D., Poulin, P. A., & Rash, J. A. (2022) · Canadian Journal of Pain · doi:10.1080/24740527.2022.2156331 · Cited by 9
“Canadian guidelines for opioid therapy in CNCP highly recommend maximizing the use of nonopioid therapies.(12) Yet, access to such CANADIAN JOURNAL OF PAIN 23”
Background
Chronic pain trials often exclude people with comorbid depressive symptoms: A secondary analysis of 346 randomized controlled trials
Cheng, D. K.-Y., Ullah, M., Gage, H., Moineddin, R., & Sud, A. (2023) · Clinical Trials · doi:10.1177/17407745231182010 · Cited by 9
“26 Thus, this study is focused specifically on trials for chronic noncancer pain.”
Background
Evaluation of a pharmacist-led interprofessional chronic pain clinic in Canada
Jorgenson, D. J., & Halpape, K. (2023) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/17151635231188334 · Cited by 9
“There are many documented barriers to increasing access to ICPCs, the greatest and most obvious being the significant expense required to operate these clinics.(1,3) Additionally, there is a well-documented lack of medical professionals, particularly physicians, who have the specialized training, expertise and willing…”
Background
At-a-glance - Concurrent monitoring of opioid prescribing practices and opioid-related deaths: the context in Nova Scotia, Canada
Schleihauf, E., Crabtree, K., Dohoo, C., Fleming, S., McPeake, H., & Bowes, M. (2018) · Health Promotion and Chronic Disease Prevention in Canada · doi:10.24095/hpcdp.38.9.05 · Cited by 9
Framing of the Opioid Problem in Cancer Pain Management in Canada
Asthana, R., Goodall, S., Lau, J., Zimmermann, C., Diaz, P. L., Wan, A. B., Chow, E., & DeAngelis, C. (2019) · Current Oncology · doi:10.3747/co.26.4517 · Cited by 9
Treatment of chronic noncancer pain in patients on opioid therapy in primary care: A retrospective cohort study
Barry, A. R., & Chris, C. E. (2019) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/1715163519887766 · Cited by 9
“Chronic noncancer pain was defined as a painful condition that persists for at least 3 months and is not associated with malignant disease.(6) Included were patients on chronic daily opioid therapy—patients exclusively on intermittent or nonprescription opioid therapy (e.”
BackgroundMethodResultInfluential
Consumo de fármacos opiáceos en la ciudad de Madrid: Factores sanitarios y sociodemográficos asociados
Pérez, E. J. P., Morales-Alonso, S., Álvarez-Crespo, B., & Benítez-Robredo, M. T. (2020) · Adicciones · doi:10.20882/adicciones.1335 · Cited by 9
Leitlinienreport der zweiten Aktualisierung der S3-Leitlinie „Langzeitanwendung von Opioiden bei nicht-tumorbedingten Schmerzen – LONTS“
Häuser, W., Klose, P., Welsch, P., Petzke, F. W., & Nothacker, M. (2020) · Der Schmerz · doi:10.1007/s00482-020-00471-z · Cited by 9
Knowledge, attitude, and barriers regarding prescribing long-term opioids among Taiwan physicians treating officially registered patients with chronic noncancer pain
Hsu, Y., Lin, S., Sung, C., Ger, L., Liou, H., Lin, T., & Ho, S. (2020) · Journal of the Chinese Medical Association · doi:10.1097/jcma.0000000000000468 · Cited by 9
Feasibility of patient-focused behavioral interventions to support adults experiencing chronic noncancer pain during opioid tapering: a systematic literature review
White, R., Bruggink, L., Hayes, C., Boyes, A., & Paul, C. L. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab007 · Cited by 10
Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care: Protocol for a randomized controlled trialb.
Klimas, J., Hamilton, M., Carney, G., Cooper, I., Croteau, N., Dong, H., Dormuth, C., Maclure, M., Socías, M., Ti, L., et al. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106462 · Cited by 7
Impact of changes in opioid funding and clinical policies on rapid tapering of opioids in Ontario, Canada
Martins, D., Khuu, W., Tadrous, M., Greaves, S., Sproule, B. A., Bozinoff, N., Juurlink, D. N., Mamdani, M., Paterson, J. M., & Gomes, T. (2021) · Pain · doi:10.1097/j.pain.0000000000002420 · Cited by 9
“with a reduced dose of 25 to 50% to minimize accidental overdose, which is recommended in the Canadian Opioid Guideline for patients who have persistent problematic pain or adverse effects from their current therapy.(4) e130 D.”
BackgroundMethodSelf-citation
Chronic Pain and Opioid Prescribing: Three Ways for Navigating Complexity at the Clinical‒Population Health Interface
Sud, A., Buchman, D. Z., Furlan, A. D., Selby, P. L., Spithoff, S. M., & Upshur, R. E. G. (2022) · American Journal of Public Health · doi:10.2105/ajph.2021.306500 · Cited by 10
Actual situation and prescribing patterns of opioids by pain physicians in South Korea
Kim, M. J., Kim, J. Y., Lim, Y. H., Hong, S. J., Jeong, J. H., Choi, H., Park, S. K., Kim, J. E., Lee, M. K., & Kim, J. H. (2022) · The Korean journal of pain · doi:10.3344/kjp.2022.35.4.475 · Cited by 9
Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study
Gomes, T., Men, S., Campbell, T. J., Tadrous, M., Mamdani, M., Paterson, J. M., & Juurlink, D. N. (2022) · PLoS ONE · doi:10.1371/journal.pone.0278508 · Cited by 9
Self-citation
The North American Opioid Experience and the Role of Community Pharmacy
Rosenberg-Yunger, Z. R. S., Ellen, M., & Mickleborough, T. (2018) · Journal of Public Health Management and Practice · doi:10.1097/phh.0000000000000807 · Cited by 9
“for patients using 90 mg of morphine equivalents or more for noncancer pain.(17) Community pharmacists can ensure that prescribers are following guidelines,”
BackgroundInfluential
Patient-level factors associated with chronic opioid use in cancer: a population-based cohort study
Cuthbert, C. A., Xu, Y., Kong, S., Boyne, D. J., Hemmelgarn, B. R., & Cheung, W. Y. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-019-05224-y · Cited by 9
New opioid use and risk of opioid-related adverse events among adults with intellectual and developmental disabilities in Ontario, Canada
Guan, Q., Men, S., Lunsky, Y., Juurlink, D. N., Bronskill, S. E., Wunsch, H., & Gomes, T. (2022) · BJPsych Open · doi:10.1192/bjo.2022.612 · Cited by 8
“18 We used a method developed by the Ontario Drug Policy Research Network to calculate daily opioid dose by converting opioid doses to milligrams of morphine equivalents, as described elsewhere.”
Self-citation
Correlates of nonfatal overdose among treatment-seeking individuals with non-heroin opioid use disorder: Findings from a pragmatic, pan-Canadian, randomized control trial
Crepeault, H., Ti, L., Jutras‐Aswad, D., Wood, E., Foll, B. L., Lim, R., Bach, P., Brar, R., & Socias, M. E. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209158 · Cited by 8
Role of Cannabis in the Management of Chronic Non-Cancer Pain: A Narrative Review
Al-Husinat, L., Obeidat, S., Azzam, S., Al-Gwairy, Y., Obeidat, F., Sharie, S. A., Haddad, D., Haddad, F. F., Rekatsina, M., Leoni, M. L. G., et al. (2025) · Clinics and Practice · doi:10.3390/clinpract15010016 · Cited by 9
Opioid Deprescribing in Patients with Noncancer Pain
Lin, C. C., & Langford, A. V. (2025) · New England Journal of Medicine · doi:10.1056/nejmcp2414789 · Cited by 8
Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study
Kirubalingam, K., Nguyen, P., Klar, G., Dion, J. M., Bell, C. M., & Beyea, J. A. (2021) · Otolaryngology · doi:10.1177/01945998211045364 · Cited by 8
“Median (IQR) 41 (19-56) 45 (23-61) 45 (25-60) 52 (43-63) 49 (41-58) 24 (8-54) 52 (15-69)”
Preexisting mental health disorders and risk of opioid use disorder in young people: A case‐control study
Marshall, T., Olson, K. L., Youngson, E. R. E., Abba‐Aji, A., Li, X., Vohra, S., & Lewanczuk, R. Z. (2023) · Early Intervention in Psychiatry · doi:10.1111/eip.13385 · Cited by 12
The epidemiology of benzodiazepine-related toxicity in Ontario, Canada: a population-based descriptive study
Campbell, T. J., Men, S., Shearer, D., Ebejer, T., Joosse, M., Quercia, J., Sanders, J., Tadrous, M., Antoniou, T., & Gomes, T. (2023) · Canadian Journal of Public Health · doi:10.17269/s41997-023-00784-3 · Cited by 8
“This change may reflect the influence of US and Canadian guidelines, published in 2016 and 2017 respectively, cautioning against the combined use of benzodiazepines and opioids for chronic non-cancer pain (Busse et al., 2017; Dowell et al., 2016).”
Background
Healthcare Access Challenges and Facilitators for Back Pain Across the Rural-Urban Continuum in Saskatchewan, Canada: Cross-Sectional Results From a Provincial-Wide Telephone Survey
Crockett, K., Lovo, S., Irvine, A., Trask, C., Oosman, S. N., McKinney, V., McDonald, T., Sari, N., Carnegie, B., Custer, M., et al. (2023) · Health Services Insights · doi:10.1177/11786329231193794 · Cited by 8
Patients’ perspectives on tapering programmes for prescription opioid use disorder: a qualitative study
Davies, L. E. M., Koster, E. S., Damen, K. F. M., Beurmanjer, H., van Dam, V. W., Bouvy, M. L., & Schellekens, A. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-075246 · Cited by 10
“13 Although opioid prescriptions are frequently introduced first in secondary care, opioid tapering is often initiated in primary care.”
Background

Authors: Busse, J. W., Craigie, S., Juurlink, D. N., Buckley, D. N., Wang, L., Couban, R. J., Agoritsas, T., Akl, E. A., Carrasco-Labra, A., Cooper, L., Cull, C., da Costa, B. R., Frank, J. W., Grant, G., Iorio, A., Persaud, N., Stern, S., Tugwell, P., Vandvik, P. O., & Guyatt, G. H.
Affiliations: University of Bern (CH)
ORCID: Busse, Jason W.
Juurlink, David N.
Buckley, D. Norman
Wang, Li
Couban, Rachel J.
Agoritsas, Thomas
Akl, Elie A.
Cooper, Lynn
Cull, Chris
Frank, Joseph W.
Iorio, Alfonso
Persaud, Navindra
Tugwell, Peter
Vandvik, Per Olav
Guyatt, Gordon H.
Venue: Canadian Medical Association Journal
Publisher: CMA Impact Inc.
Published: 2017-05-07
Volume: 189
Issue: 18
Pages: E659-E666
ISSN: 0820-3946 (ISSN-L)
1488-2329
DOI: 10.1503/cmaj.170363
PMC: PMC5422149
OpenAlex: W2612284626
Cited by: 707
References: 50
Citations by year: 2026: 37 · 2025: 58 · 2024: 71 · 2023: 59 · 2022: 82 · 2021: 107 · 2020: 105 · 2019: 86 · 2018: 67 · 2017: 29
FWCI: 73.70
Type: journal article
Language: en
Open access: gold
doi.org
Locations: Canadian Medical Association Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
BORIS (University Library Bern) (submittedVersion)
Funders: U.S. Department of Veterans Affairs (IK2 HX001914)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Keywords: opioid therapy, chronic non-cancer pain, pain management, opioid prescribing
MeSH terms: Analgesics, Opioid, Dose-Response Relationship, Drug, Humans, Opioid-Related Disorders, Pain Measurement, Primary Health Care, Treatment Outcome, Drug Monitoring, Chronic Pain

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Guideline for opioid therapy and chronic noncancer pain

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