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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 

Prescription Regulation Summary Chart (Summary of Laws)

Opioid information

Health Quality Ontario
Opioid Prescribing for Chronic Pain
Opioid Prescribing for Acute Pain

National Pain Centre, McMaster University ­
Canadian Guidelines for Use of Opioids in Chronic Non-Cancer Pain

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 

NPs also asked for a sample opioid medication treatment agreement and information on opioid tapering, which are both available through the National Pain Centre.

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. 

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

Clinical Tools

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.

Treating Opioid Dependence

Ontario’s Narcotics Monitoring System

Fentanyl Patch Return Requirements

ECHO Ontario

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:

Palliative Care

Pallium Canada has palliative care resources (e.g., peer-reviewed education, resources and clinical decision-making) –

Cannabis (Marijuana)

Federal Resources

Page mise à jour le mars 19, 2018