Grant: Project Grant

In 2017, the Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain was released. The guideline encouraged physicians to limit access to opioids to patients with no indication of past substance use disorder, taper patients whose daily dose exceeded new 'watchful dose' thresholds and prioritize nonpharmacologic therapy. Although intended for patients with chronic noncancer pain, incorrect interpretation of the guideline resulted in aggressive weaning without consent and caused debilitating pain, serious withdrawal symptoms, and increased risk of overdose for other patient groups (e.g., people living with cancer, acute pain, sickle cell disease, chronic kidney disease, diarrhea or cough). This project aims to measure the effects of the 2017 guideline on guideline exempt patients' access to opioids (e.g., patients experiencing acute pain following trauma or surgery, living with cancer, receiving palliative care, or otherwise treated with opioids for the management of chronic cough, diarrhea or conditions such as sickle cell anemia), and the effects of these changes on their health and health service use. We will use patient-level administrative health records from British Columbia, Ontario and Quebec to: 1.Quantify the effect of the 2017 guideline on guideline exempt patients' access to opioids; 2.Compare the survival of patients on opioid analgesics to non-initiators, and determine if alternative pharmacotherapies are commensurate to opioids; and 3.Evaluate the population-wide costs and benefits of the 2017 guideline. This project is of strategic importance to Health Canada. Results from the study will address the previously overlooked but critical question of the effects of aggressive prescription opioid interventions on patients' health, globally.