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Controlled Substances - Resources and References
NPs are accountable for implementing evidence-informed therapeutic interventions. When CNO surveyed NPs in 2017 on the topic of controlled substances, NPs asked for a variety of information and tools to support their practice. In response, we are providing the resources listed below for NPs to use in making evidence-informed decisions.
Ontario College of Pharmacists resource for telephone and other verbal orders
Government of Canada
Opioids – Services and information
Health Canada’s web resource on the Methadone Program
National Pain Centre, McMaster University
NPs can find the following resources in the Canadian guideline:
- See page 68 for opioid conversion table
- See page 15 for specific treatments available for the management of chronic non-cancer pain
- See page 28 for opioid options for initiating a trial of therapy for clients with chronic non-cancer pain, who do not have a current or past substance use disorder and do not have other active psychiatric disorders, but who have persistent problematic pain despite optimized non-opioid therapy
Center for Disease Control, United States
Center for Disease Control Guideline for Prescribing Opioids for Chronic Pain
NPs asked for a variety of information/tools to support their practice. Some of these can be found in the CDC guideline; for example, table 2 is a morphine milligram equivalent table.
- The CDC website also has the following additional tools on their resources page:
Institute for Safe Medication Practices Canada
Institute for Safe Medication Practices Canada Safety Bulletin. (2017). Helping Patients and Practitioners to Understand Opioid Potencies and Overdose Risk
NPs also asked for more information about morphine equivalents. Page 3 of the bulletin listed above has an opioid infographic to help you understand the concept of morphine equivalence, the increased risk of harm at higher levels of morphine milligram equivalents per day and where in the risk profile a specific opioid regimen exists.
The National Academies of Sciences, Engineering and Medicine
Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use
Centre for Effective Practice
Pain Management and Opioids
Choosing Wisely Canada
Evidence Exchange Network for Mental Health and Addictions
Portico - A network of addiction and mental health sites from across Canada
NPs asked for a variety of tools including screening questionnaires and risk assessment tools. There are a number of tools available through Portico, such as screening and assessment tools.
Also, in answer to NPs’ request for resources to connect with other clinicians and specialists, here is Portico’s online forum where you can view and participate in a variety of discussions about topics of interest.
The Well - Centre for Effective Practice
Opioid Tapering Template - to support primary care providers in discussing the value of opioid tapering with all adult patients currently prescribed an opioid and to support their patients in reducing opioid dosages in a safe and effective way.
Opioid Manager - designed to support health care providers in prescribing and managing opioids for patients with chronic non-cancer pain.
Treating Opioid Dependence
- Health Quality Ontario - Opioid Use Disorder (Opioid Addiction)
- Centre for Addiction and Mental Health - Buprenorphine/Naloxone for Opioid Dependence
- Canadian Agency for Drugs and Technologies in Health (CADTH) report - Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical and Cost-Effectiveness and Guidelines
- Canadian Centre on Substance Abuse – This site has resources on addiction recovery, and care pathways for treatment and supports
- Canadian Medical Association Journal (March 2018) - Management of opioid use disorders: a national clinical practice guideline
- British Columbia Centre on Substance Abuse and B.C. Ministry of Health - A Guideline for the Clinical Management of Opioid Use Disorder
- The College of Physicians and Surgeons of Ontario – Methadone Maintenance Treatment Program Standards and Clinical Guidelines and Policy for Methadone Maintenance Treatment for Opioid Dependence
- Centre for Addiction and Mental Health – Opioid Agonist Maintenance Treatment and Methadone treatment resources for professionals
- Canadian Research Initiative in Substance Misuse (CRISM) – CRISM National Guideline for the Clinical Management of Opioid Use
Opioid Substitution Therapies Drug Information Line
The Opioid Substitution Therapies Drug Line provides free access to drug information experts who can answer questions about methadone and buprenorphine/naloxone in the treatment of addiction.
Call 1 888 519-6069. Phone line is open Monday to Friday, 0900 hours – 1700 hours.
Ontario’s Narcotics Monitoring System
- Government of Ontario – Narcotics Safety and Awareness Act, 2010
- Government of Ontario – Information about the Narcotics Monitoring System
Fentanyl Patch Return Requirements
- Government of Ontario – Safeguarding our Communities Act (Patch for Patch Return Policy), 2015
- Ontario College of Pharmacists & College of Physicians and Surgeons of Ontario – Patch-for-patch Fentaynl Return Program Fact Sheet
To help NPs connect with other clinicians and specialists, Project ECHO in an option.
Project ECHO links expert inter-professional teams at an academic hub with primary care providers in local communities. Here are some of their resources:
- Project Echo Home page: https://www.echoontario.ca/Home.aspx
- Project Echo chronic pain and opioids program: https://www.echoontario.ca/Echo-Clinic/Chronic-Pain.aspx
- Project Echo mental health and addictions program: https://www.echoontario.ca/Echo-Clinic/Mental-Health-and-Addictions.aspx
Pallium Canada has palliative care resources (e.g., peer-reviewed education, resources and clinical decision-making) – http://pallium.ca/
- Health Canada – Information for Health Care Professionals: Cannabis and the cannabinoids
- College of Physicians and Surgeons of Ontario. (2016). Marijuana for medical purposes
- The National Academies of Sciences and Engineering – The Health Effects of Cannabis and Cannabinoids
- Government of Canada – Controlled Drugs and Substances Act and regulations(This link also has a list of drug schedules.)
- Health Canada – Office of Controlled Substances contact information
- Canadian Council of RN Regulators – Joint Statement of Action to Address the Opioid Crisis