New guidelines released Monday in the Canadian Medical Association Journal encourage doctors to first look to non-opioid therapy to treat patients before prescribing the powerful painkillers.

The guidelines were developed by a team of clinicians, researchers and patients at the National Pain Centre amid growing concerns about opioid use in Canada.

The National Pain Centre released 10 new recommendations, which provide an update on the last set of guidelines, released seven years ago.

“The evidence shows us that opioids are likely to provide similar benefits to non-opioid therapies, but non-opioid therapies do not entail the risk,” said Dr. Jason Busse, a researcher at the National Pain Centre at McMaster University in Hamilton.

“You are not going to become addicted to opioids if you’re pursuing exercise. You’re not going to overdose on opioids if you’re engaged in cognitive behavioural therapy.”

“We’ve recommended looking to non-opioid therapies first. If non-opioid therapies still do not resolve pain and improve function sufficiently for patients, then we are suggesting that a trial of opioids could be appropriate, but we’re recommending to be avoided in certain high-risk populations.”

Dr. Busse said the National Pain Centre has a commitment to release new guidelines approximately every five years.

“There were plans in place to update the guidelines, but the current awareness around the opioid epidemic does provide us with an important opportunity for greater dissemination of our findings.”

“As the rates of overdose and opioid toxicity increase, I think that clinicians and patients have been revisiting the risk/benefit ratio associated with opioids for chronic pain,” Dr. Busse said.

“In terms of our guidelines, I think that they do now synthesize all of the evidence that’s currently out there, so we’re able to give stakeholders, patients and clinicians an up-to-date synthesis of the best evidence to better inform their treatment decisions that they make.”

The guidelines are recommendations and not regulatory requirements.

Dr. Busse said it will be up to regulatory bodies from each province to decide if they want to adopt the new guidelines.

According to numbers from the Office of the Chief Medical Examiner, there were 80 opioid overdose deaths in Manitoba in 2016. That’s down slightly from 2015 when 84 people died. There were 94 opioid overdose deaths in 2014 and 87 in 2013.

The number of cases involving fentanyl, carfentanil, and furanyl fentanyl went up in 2016. Thirty-one people died in 2016 of an overdose where one of the three drugs was either a primary or contributing factor. That’s up from 20 in 2015, 13 in 2014 and 11 in 2013.

Opioid overdose deaths: (primary and contributing) (Source: OCME)

  • 2013: 87 deaths
  • 2014: 94 deaths
  • 2015: 84 deaths
  • 2016: 80 deaths

Fentanyl, Carfentanil and Furanyl Fentanyl overdose deaths: (primary and contributing) (Source: OCME)

  • 2013: 11
  • 2014: 13
  • 2015: 20
  • 2016: 31