Opioid prescribing is a surrogate for inadequate pain management resources.

The registrar of the College of Physicians and Surgeons of Ontario stated in 2010 that “opioids are an important part of the modern arsenal for treating chronic non-cancer pain.”1 He noted that clear guidance on the prescribing of opioids was needed and that the National Opioid Use Guideline Group had led a project to develop the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.2 A synopsis of the guideline was published in CMAJ, the journal of the Canadian Medical Association,3 and in Canadian Family Physician.4,5 The guideline notes that “not enough is known about the long-term benefits, risks, and side effects of opioid therapy; more research is needed in these areas.”2 In the limitations section, it is stated that the guideline “addresses only one modality for managing [chronic noncancer pain]—opioid therapy, and it does not discuss or provide guidance about other options.”2 Although opioid therapy can be an adjunct therapy for chronic noncancer pain, these other therapeutic options need to be implemented before resorting to opioids. We contend that opioid prescribing by family physicians and other specialists alike is a surrogate for inadequate pain management resources in our communities and is the culmination of 2 decades of “pharmaceuticalization” of the treatment of chronic pain with drugs coupled with unscrupulous marketing by the pharmaceutical industry. Guidelines to promote the safe and effective use of opioids were needed given the frequency of opioid prescribing and the high doses at which they have been prescribed over the past 15 years.6 In Canada, between January 1, 2006, and December 31, 2011, Ontario had the highest annual rate of high-dose oxycodone and fentanyl dispensing (756 tablets and 112 patches, respectively, per 1000 population), while Alberta’s rate of high-dose morphine dispensing was the highest in Canada (347 units per 1000 population).7 Quebec had the lowest rate of high-dose oxycodone and morphine dispensing (98 and 53 units, respectively, per 1000 population).7 A large body of research documents the adverse consequences of opioid prescribing, including addiction and death,8-14 while there is no compelling evidence that long-term opioid use imparts benefits that outweigh the risks.15-21 Rates of opioid-related deaths in Ontario increased between 1991 and 2010, from 12.2 to 41.6 deaths per million, a rise of 242%, and by 2010, years of potential life lost attributable to opioid-related deaths (21 927 years) exceeded those attributable to alcohol use disorders (18 465 years) and pneumonia (18 987 years).11 In the United States the rate of death from overdoses of prescription opioids more than quadrupled between 1999 and 2010.14