Opioid prescription for acute post-surgical pain: Mitigating the risk of misuse and harm

Study Lead

Mona Sawhney

Associate Professor

Study Co-investigators

Fiona Campbell, Department of Anesthesiology and Pain Management, Hospital for Sick Children, Toronto

Hance Clarke, Department of Anesthesiology and Pain Management, University Health Network, Toronto

Andrea Furlan, Physiatry, University Health Network, Toronto

Ian Gilron, Department of Anesthesiology and Pain Management, Faculty of Health Sciences, Queen’s University, Kingston

Ahmed Hassan, Center for Addiction and Mental Health, Centre de Toxicomania et de sante mentale, Toronto

Colin McCartney, Department of Anesthesiology, Faculty of Medicine, University of Ottawa/Universite d’Ottawa.

Aska Patel, Central West Local integration Network, Brampton

Amanda Ross-White, School of Library, Archival and Information Studies, Faculty of Health Sciences, Queen’s University, Kingston

Alexandra Stratton, Department of Orthopedic Surgery, Ottawa Hospital General Campus

Sarah Tierney, Department of Anesthesiology, Ottawa Hospital General Campus

What? The increase in adverse events related to long term opioid use and opioid misuse is a public safety crisis impacting Canadians. In 2018, 4460 people lost their lives to opioid related overdoses, with 4172 (93.5%) of these deaths being accidental. An alarming increase in the percentage of people who are hospitalized or visit an emergency department due to opioid poisoning has also been reported.

Personal prescriptions of opioids for pain following surgical or dental procedures have been shown to account for a third of misuse, or non-medicinal drug use.

Despite these numbers, there is currently a lack of screening tools to identify which opioid-naïve patients are at risk of engaging in inappropriate use after being prescribed opioids to manage post-operative pain.

Why? The optimal identification of patients who are at risk of prescription opioid misuse or long-term opioid use can help decrease the adverse events associated with inappropriate opioid use.

The goal of this project is to develop a best practice recommendation document that defines both the assessment that should be conducted prior to prescribing opioids for acute post-surgical pain and the follow-up to ensure appropriate use.

How? To develop these practice recommendations we will bring together an interprofessional team of experts that will 1) review existing evidence regarding the assessment and screening for opioid misuse risk in opioid naïve patients, 2) bring together experts and key stakeholders (clinicians, patients, educators, researchers, policy makers) to develop a practice recommendation based on available evidence and clinical expertise 3) develop of an integrated knowledge translation plan and 4) disseminate the recommendations to multiple stakeholder groups.

Impact of findings: By generating best practice statements, our objective is to provide concrete guidance to the practice community. The guidelines will allow point-of-care health professionals throughout the health system to prevent long term opioid use, opioid misuse, and opioid related harms in surgical patients.

Funded By

CIHR Planning and Dissemination grant