Task Force Calls for Update of Canada’s Opioid Guideline
/By Pat Anson, PNN Editor
A task force created by Health Canada to study the needs of nearly 8 million Canadians with chronic pain has released its third and final report, saying there is an urgent need for the federal government to address untreated pain and improve access to pain care.
"It is a critical time for action to address unmanaged pain across Canada. Chronic pain is largely invisible and for too long people with pain have faced stigma and had to navigate significant gaps in access to care,” said Fiona Campbell, MD, Co-Chair of the Canadian Pain Task Force.
The task force report – “An Action Plan for Pain in Canada” – calls for more pain research, improved training for pain care providers, and better coordination of government pain policies.
Notably, it also calls for an expansion of Canada’s 2017 opioid prescribing guideline, even while acknowledging the problems the guideline has caused by making access to opioid medication more difficult.
“Efforts to address opioid-related harms have led to serious and unintended consequences for some people living with chronic pain, including unmanaged pain, increased stigma, reduced access to care for people who use opioids for pain relief, and preventable deaths,” the task force reported. “Despite widespread decreased opioid prescribing, and investments in a continuum of harm reduction, treatment, and prevention initiatives, there are record high numbers of overdose deaths in Canada.”
The report said the guideline should be updated “to better balance the risks of opioids with the risks of opioid discontinuation.” Additional guidance was also needed for treating short-term acute pain, alternatives to opioids, interpreting dose limits, and “best practices in deprescribing.”
The Canadian guideline was modeled after the CDC’s 2016 opioid guideline, which is being updated for many of the same “unintended consequences.” Opioid prescribing in the U.S. is at 20-year lows, while overdose deaths are at record highs.
‘Rearranging the Deck Chairs’
Some critics were unimpressed with the task force report, saying it equates opioids with addiction and doesn’t address how to improve access to opioid pain relievers.
“Health Canada’s Pain Task Force has finally finished rearranging the deck chairs on a ship that sank a decade ago,” Barry Ulmer, Executive Director of the Chronic Pain Association of Canada, said in a statement. “More and more Canadians suffer serious ongoing pain and, since 2011, fewer and fewer opiates — still the only proven remedy for serious acute and chronic pain — are prescribed to treat it.
“Unsurprisingly, a record rise in overdose deaths among those suffering from addictions who can’t find safe supply is tracking the crackdown and the rise of untreated pain, along with suicides among abandoned patients.”
The task force said there was an “an emerging consensus” on how to improve pain care in Canada, and that it was up to Health Canada and the federal government to fund and combat a public health emergency.
"People living with pain deserve relief from their pain, reassurance that they matter, and access to services required to improve their quality of life. We will continue to work with people with lived and living experience, as well as our partners and stakeholders, to explore new approaches and determine our next steps,” said Minister of Health Patty Hajdu.
Hajdu also announced that a $2.8 million grant was being given to the Toronto-based Centre of Effective Practice to provide treatment to patients living with addiction, mental illness and chronic pain. The funding comes from a Health Canada substance abuse program.
