Reduce opioid prescriptions in favour of non-drug alternatives, pain management coalition urges

A national group of health-care providers is calling for a new approach to pain management in Canada that cuts down on the prescribing of opioids in favour of more non-pharmacological alternatives.

Coalition presents report at Calgary meeting calling for more access to psychologists, physiotherapists

The health-care system in Canada needs to be better equipped to offer patients non-pharmacological alternatives to opioids, a coalition of national groups says. (CBC)

A national group of health-care providers is calling for a new approach to pain management in Canada that cuts down on the prescribing of opioids in favour of non-pharmacological alternatives.

The Coalition for Safe and Effective Pain Management outlined its ideas Monday in a report at the Canadian Centre on Substance Use and Addictions' Issues of Substance 2017 conference in Calgary. 

"Although the opioid crisis is complex, part of the solution is to reduce the number of people newly introduced to opioids by rethinking the role of, and access to, non-pharmacological alternatives in pain management," says the report, Reducing the Role of Opioids in Pain Management.

The coalition says the absence of affordable options in Canada's health-care system contributes to an over-reliance on opioids as a first-line treatment.

"Many in Canada do not know that non-pharmacological alternatives like psychology, chiropractic, occupational therapy and physiotherapy exist, and if they do, they often have difficulty accessing them," the report says.

Opioids, on the other hand, are funded by all provincial and territorial drug plans and most extended health benefits plans.

Among the coalition's members are national associations of occupational therapists, chiropractors, physiotherapists, psychologists, nurses and pain and orthopedic experts.

The report is careful to make clear that its recommendations are not targeted at current opioid users or prescriptions for cancer or palliative care.

"It is important that people are not left in pain or without confidence that they will find relief," the report says.

"Patients who truly benefit from opioids should be able to get them."

But studies indicate opioids only provide limited improvements in pain when compared to other treatment options — and they come with huge risks, the report says.

Up to 26% become addicted 

The authors note that studies have suggested as many as 26 per cent of patients taking opioids will become addicted after their first prescription.

Canada has the second-highest rate of opioid prescribing in the world — more than 19 million opioid prescriptions were filled in Canada in 2016 — despite having very similar pain-care needs as compared with European nations, the report says.

The most commonly treated conditions being treated among Canadians using opioids are chronic low back pain, chronic neck pain, fibromyalgia and chronic headaches.

"The demand for opioids is based the misconceptions that all pain, including chronic pain, can be treated with a pill," the report says.

The coalition argues that the first priority in devising a new approach to pain management must be to address the lack of access to publicly funded, non-pharmacological care for marginalized and vulnerable populations.