Opioid Stewardship
Coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health.
Opioid medications are used to treat pain. Opioids are also known as narcotics. In recent years more and more Canadians are using opioids, and research indicates that we are now the world’s second largest consumer of opioids. Along with this increased use of opioids there has also been a corresponding and alarming increase in the harm from opioids.
Through our ongoing analysis of medication safety incidents, we have found that opioids are frequently associated with harmful consequences-including death-when they are prescribed, used or administered incorrectly or in error.
Opioid Stewardship may be described as coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health. This web page has been developed to help the public and health care practitioners become better informed about opioids and to help reduce and prevent harm.
Patients and Families
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Opioids for pain after surgery
Download: English | French | Acknowledgements
Endorsements: Best Practice in Surgery, Canadian Association of General Surgeons, Canadian Orthopaedic Association, Mackenzie Health, North York General Hospital, Ontario Health, Providence Health Care, Saskatchewan Health Authority, Sinai Health System, University Health Network, University of Toronto, Winchester District Memorial Hospital -
Opioids for short-term pain
Download: English | French | Acknowledgements
Endorsements: Neighbourhood Pharmacy Association of Canada, Ontario Health, Saskatchewan Health Authority -
Managing pain after wisdom teeth removal
Download: English | French | Acknowledgements
Endorsements: Ontario -
Opioid Handout
Download: English | French
Endorsements: Neighbourhood Pharmacy Association of Canada, Pharmasave, Health PEI, Saskatchewan Health Authority -
Safe Storage and Disposal Information Card
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Methadone for Opioid Use Disorder
Download: English | French | Acknowledgements
Endorsements: Saskatchewan -
Buprenorphine/Naloxone for Opioid Use Disorder
Download: English | French | Acknowledgements
Endorsements: Saskatchewan -
Structured Opioid Therapy
- Frequent vomiting from use of cannabis (pot/marijuana) | Acknowledgements
- Videos:
- Question Opioids – 2017
- Consumers Can Help Prevent Harm from Opioid Use!: English | French – 2013
- Newsletters and alerts:
- Misconceptions about Medicines that Could Be Deadly: What works for me will work for you – June 2016
- Misconceptions about Medicines That Could Be Deadly: It doesn’t matter where I keep my medicines – January 2016
- Beware: Medicine Names May Sound Alike, but the Medicines May Be Very Different – March 2015
- Confusion with a Baby’s Dose of Medicine – January 2015
- Sharing Opioid Medications Can Be Deadly – September 2014
- Informed Consumers Can Help Prevent Harm from Opioid Use – March 2013
- Take Care with Medicine Patches – July 2012
Prescribing
Opioid Prescribing Supports:
- Morphine Infographic: English | French
- Safer Decisions Save Lives: Key Opioid Prescribing Messages for Community Practitioners – ISMP Canada Safety Bulletin
- Safe Storage and Disposal of Opioids Factsheet:
Opioid Prescribing Tools:
Pain Check In: The Pain Check In is a structured approach to information gathering using pre-existing instruments that will give prescribers better information with which to assess the pain patient and engage in collaborative decision making. The tool helps to standardize some of the information collected during pain related visits and addresses a lack of consistency in how clinicians approach pain related visits. The Pain Check In allows the patient to complete a series of paper or electronic forms in the waiting room prior to the visit that can be placed in the paper chart, or EMR. The physician can then review the information in order to facilitate sound decisions about pain management.
- Pain Check In — Paper Version:
- Pain Check In — EMR Version (Telus PS Suite/Ocean):
- Tool (Available through the CognisantMD website)
- Prescriber Guidebook
- Demonstration Video
- Functional Specifications for Clinical Decision Support Systems
- Testing of a Prototype Clinical Decision Support System
Healthcare Providers
ISMP Canada Safety Bulletins and Other Resources for Healthcare Providers:
- CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 | MMWR
- Medication Incidents that Increase the Risk of Falls: A Multi-Incident Analysis – December 2015
- Opioid-Related Deaths Associated with Medication Incidents – November 2014
- Designing Effective Recommendations – April 2013
- General:
- Naloxone Saves Lives – September 2014
- Safe Pain Control in the Emergency Department – April 2014
- Lowering the Risk of Medication Errors: Independent Double Checks – January 2005
- High Alert Drugs and Infusion Pumps: Extra Precautions Required – April 2004
- Safeguard Against Errors with Long-Acting Oral Narcotics – September 2003
- Narcotic Safeguards – The Challenge Continues – February 2002
- Ontario Medication Safety Support Service (MSSS) Narcotics Safety Project: Implementing System Safeguards to Prevent Error-Induced Injury with Opioids (Narcotics) – October 2006
- Narcotic (Opioid) Medication Safety Initiative: Priority Recommendations from the Ontario Hospital Narcotic (Opioid) Collaborative Project – January 2005
- Care of Children:
- Advancing Opioid Safety for Children in Hospitals – March 2014
- Top 5 Drugs Reported as Causing Harm through Medication Error in Paediatrics – August 2009
- A National Collaborative: Advancing Medication Safety in Paediatrics
- Advancing Medication Safety in Paediatrics – Paediatrics Opioid Consensus Guidelines – December 2012
- Paediatric Opioid Safety Resource Kit – March 2012
- Medication Safety Self Assessment Programs:
- Opioid-Related Incident in a Long-Term Care Home – December 2012
- Medication Incidents Occurring in Long-Term Care – December 2010
- Safer Decisions Save Lives: Key Opioid Prescribing Messages for Community Practitioners – November 2016
- Potentially Inappropriate Medication Use in Older Adults: A Multi-Incident Analysis – June 2016
- Multi-Incident Analysis on Incidents Involving Patients: Lessons Learned from a Provincial Pilot Study – Spring 2016
- Deaths Associated with Medication Incidents Occurring Outside Regulated Healthcare Facilities – February 2014
Medications
Information related to specific medications (in alphabetical order):
Codeine:
Fentanyl (transdermal):
- Analysis of International Findings from Incidents Involving Fentanyl Transdermal Patches – December 2009
- Fentanyl Patch Linked to Another Death in Canada – November 2007
- Transdermal Fentanyl: A Misunderstood Dosage Form – August 2006
- An Opioid-Related Death in a Small Community Hospital – December 2014
- Decimal Point in New Strength of HYDROmorph Contin Leads to an Opioid Overdose – November 2014
- Safeguards for HYDROmorphone – Results of a Targeted Demonstration Project – November 2013
- HYDROmorphone remains a high-alert drug – February 2013
- Identifying Knowledge Deficits Related to HYDROmorphone – June 2012
- HYDROmorphone Knowledge Assessment Survey Results – April 2012
- HYDROmorphone Knowledge Assessment Survey: Questions and Answers
- 2012/09/13 – Identifying Knowledge Deficits Related to Hydromorphone
- 2012/02/17 – Hydromorphone Découvrir ce dont on ne sait pas
- 2012/02/09 – Hydromorphone Discovering What We Don’t Know
- Hydromorphone Intended for an Adult Patient Inadvertently Administered to an Infant – September 2008
- Shared Learning – Reported Incidents Involving Hydromorphone – December 2006
- An Omnipresent Risk of Morphine-Hydromorphone Mix-ups – June 2004
- Event Analysis Report: Hydromorphone/Morphine Event – December 2004
- Meperidine (Demerol): Issues in Medication Safety – August 2004
- Methadone Medication Incidents in Community Pharmacy – February 2015
- Change in Methadone Concentration Results in an Overdose in a Post-Partum Patient – February 2015
- Methadone: Not Your Typical Narcotic – December 2003
- Ontario College of Pharmacists Pharmacy Connection: Methadone Medication Incidents – Summer 2013
Storage and Disposal
- Canada Recyclepedia app: iPhone users – iTunes Store, Android users – GooglePlay
- Don’t Throw it out – Bookmark
- Promo Order Form
- For more information about the Medications Return Program visit Health Products Stewardship Association
Additional Resources and Projects
Additional collaborative projects and resources related to safe management of opioids:
- CADTH – Opioid Evidence Bundle
- Ontario Ministry of Health Long-Term Care Prescription Pain Medication: Know the potential risks of opioid use: Poster | Brochure
- Canadian Centre on Substance Use and Addiction – Opioids Resources
- University of Waterloo: Naloxone at pharmacies: what you need to know to combat the opioid crisis – August 2016
- House of Commons Standing Committee on Health: The Role of Health Care, Practitioners in the Prevention and Treatment of Prescription Drug Misuse, Abuse and Dependence – November 2013
- Deaths Associated with Medication Incidents: Learning from Collaborative Work with Provincial Offices of the Chief Coroner and Chief Medical Examiner – August 2013
- The ISMP Canada Coroner’s and Medical Examiner’s Project – Old Problems and New Findings (webcast) – October 2013, Sunnybrook Health Sciences Centre
- National Advisory Council on Prescription Drug Misuse: First Do No Harm – Responding to Canada’s Prescription Drug Crisis – March 2013
- A Year in Review: Critical Medication/IV Fluid Incident Reporting Through the National System for Incident Reporting – January 2013
- College of Physicians and Surgeons of Ontario Dialogue: Identifying Knowledge gap for Hydromorphone – 2012
- Collaboration with the Office of the Chief Coroner for Ontario: Report for 2009 to 2011
- Healthcare Quarterly: Identification of Medication Safety Indicators in Acute Care Settings for Public Reporting in Ontario – October 2010
- Canadian Journal of Hospital Pharmacy: Narcotic (opioid) safety: an ISMP Canada Medication Safety Support Service project – June 2005