Opioid Stewardship

The following resources are intended to support pharmacists in their role as opioid stewards. The resources offer general opioid stewardship education and specific information to help guide decision making to ensure safe and responsible use of opioids.

The resources found in the Assess Appropriateness and Patient Communication tabs have been specifically curated to support pharmacists using the Prescriptive Authority Decision-Making Framework for Level I prescribing. Navigate to the Continuing Education tab, or the General Tools and Resources (right side of the page), for broad learning.

To help guide the use of these resources, USask CPE has developed a short open-access module that offers a step-by-step process for assessing opioid prescriptions, and some tips for challenging conversations that may arise with opioid stewardship.

Determining Appropriate Dose and Regimen

Opioid Analgesics: Drug Comparison Chart 

  • RxFiles 
  • Easy-to-use resource to compare the relative potencies of different opioid medications

Opioid Manager 

  • Center for Effective Practice 
  • Supports prescribing and managing opioids for patients with chronic non-cancer pain

Calculating Total Daily Dose of Opioids for Safer Dosage

  • Center for Disease Control and Prevention (CDC) 
  • Poster and infographic

Appropriate Opioid Quantities for Acute Pain

  • ISMP 
  • Several resources including infographic on appropriate quantities of opioids for short-term pain and checklist for assessing opioid prescriptions for acute pain (see Clinical Resources: Health Care Provider)

Navigating Opioids for Chronic Pain 

  • ISMP
  • Infographic
Guidelines Acute Pain

Opioid Prescribing for Acute Pain 

  • Health Quality Standards Ontario 
  • Covers appropriate prescribing, monitoring, and tapering of opioids to treat acute pain for people aged ≥ 15
  • Resource does not address opioid prescribing for chronic pain, end-of-life care, or the management of opioid use disorder in-depth

Clinical Practice Guidelines for Prescribing Opioids for Pain 

  • Centers for Disease Control and Prevention (CDC) 
  • This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids for outpatients aged ≥18 years
Guidelines Chronic Pain

Guideline for Opioid Therapy and Chronic Noncancer Pain 

  • Canadian Medical Association Journal (CMAJ)

PEER Simplified Chronic Pain Guideline 

  • Canadian Family Physician (CFP) 
  • Covers the management of chronic pain and highlights the best available evidence including both benefits and harms for a number of treatment interventions
  • Includes osteoarthritis, low back pain, and neuropathic pain

Chronic Pain (Primary and Secondary) in Over 16s: Assessment of All Chronic Pain and Management of Chronic Primary Pain 

  • National Institute for Health and Care Excellence 
  • This guideline covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over

Management of Chronic Non-Cancer Pain 

  • Center for Effective Practice 
  • Target Audience: Primary care providers (physicians and nurse practitioners)
  • Curated notes: helps providers develop and implement a management plan for adult patients with chronic non-cancer pain (CNCP)
Guidelines Post-Surgery

Prescription of Pain Medication at Discharge after Elective Survey 

  • University of Toronto 
  • Recommended amount of opioids for common procedures, implementation tools, and patient education resources
Palliative Care

Symptom Management Guidelines 

  • BC Centre for Palliative Care 
  • These guidelines are intended for inter-professional clinicians working with adults living with advanced life-limiting illness
Dental Pain

The Role of Opioids in the Management of Acute and Chronic Pain in Dental Practice 

  • Royal College of Dental Surgeons of Ontario 
  • The purpose of this document is to guide dentists in the appropriate role of opioids in the management of acute and chronic pain in dental practice, and to present “best practices” for their use
Other Tools to Support Appropriate Use

Chronic Pain Pathway Provider Information 

  • Saskatchewan Health Authority (SHA) 
  • Resource document is a tool for primary care providers to optimize care for people living with chronic pain

Comparing Treatment Opioids for Pain- the C-TOP Tool 

  • PEER 
  • Shows the potential benefits and possible harms associated with different treatments for pain
  • Highlights key things to consider when choosing treatment (most common side effects, cost, etc.) 

Opioid Therapy Monitoring Tool 

  • Canadian Association of Schools of Nursing 
  • Monitoring tool to help document opioid effects over time

Pain: Overview of Approach and Treatment Considerations

Chronic Pain Therapy: Pain Colour Comparison Chart 

  • RxFiles
Shared Decision-Making Patient Resources

ISMP 

SafeMedicationUse.ca 

RxFiles 

Having Conversations with Patients about Opioids

Tapering opioids using motivational interviewing 

  • Canadian Family Physician 
  • This article shows how to apply a motivational interviewing approach to a conversation with a patient. 

Motivational Interviewing

  • Centers for Disease Control and Prevention 
  • Free module
  • Explains how motivational interviewing may be applied to the management and treatment of patients regarding opioid use.

Challenging Conversations Around Opioids for Acute Pain Handout

  • ISMP 
  • Scripted statements to support challenging conversations.

Pharmacist’s Virtual Communication Toolkit: Engaging in Effective Conversations About Opioids

  • NAPRA
  • Designed to provide pharmacists with communication tips and strategies for engaging in effective conversations with patients about opioids
  • Links to other resources and references to help pharmacists become more comfortable engaging with patients regarding opioids.

Opioids in Acute Pain: Ensuring Safer Daily Doses and Safer Quantities

  • CAMH & ISMP Canada
  • Audience: Pharmacists
  • Cost: Free (online modules)

Wise Prescribing and Deprescribing

  • Colleges of Physicians and Surgeons of Alberta & Physician Learning Program
  • Audience: Community healthcare providers
  • Cost: Free (online modules)

Safer Opioid Prescribing: Best Practices in Chronic Pain Management and Opioid Prescribing

  • University of Toronto
  • Audience: Physicians and other healthcare providers
  • Cost: $$$ (Webinars)

Opioids Clinical Primer: Safer Opioid Prescribing Strategies

  • McMaster University
  • Audience: Community healthcare providers
  • Cost: Free (online course)

An Intervention to Empower Community Pharmacists to Implement Opioids Stewardship in Acute Pain (Opioid summary from CPhA)

  • Canadian Pharmacy Association (CPhA)
  • Audience: Pharmacists
  • Cost: Free (webinar)

 

Be sure to check out resources and databases found on the Saskatchewan Health Information Resource Program (SHIRP) to help you with your clinical decision making and opioid stewardship activities. medSask’s favourites include RxFiles, Dynamed, and CPS 

Share your feedback with medSask. Click here to report an error, omission, or barrier to using our opioid stewardship page.