It is well established chronic pain is a major health care problem that is largely ignored in the
health care field and by those making health care policy decisions. People with pain can attest to
this as they continue to be stigmatized, marginalized and often simply ignored. The recently
released Guidelines for the use of Opioids in Canada re-enforces this and raises another barrier to
the treatment and management of pain. These guidelines, which were no doubt influenced by the
recent release of the extremely flawed and biased guidelines by the CDC in the United States,
written by a small group of anti-opiate crusaders with strong ties to a large drug rehab chain,
seem to reflect more attention to people with addictions and not people with pain.
We are not opposed to guidelines when they are relevant and appropriate, but feel strongly these
are again premature and relate more to addiction medicine then pain medicine. This is obvious
when one looks at the official Guideline Panel. Although, which we find audacious, they did not
list the backgrounds and ALL affiliations these members have; our early research indicates most
have little or no experience on the front lines of pain medicine and are exceedingly intertwined.
In addition, publishing the draft recommendations without the guideline’s main text and the
supporting evidence provides limited information for anyone to sufficiently evaluate the
guidelines. This is much like the recent Opioid Summit in Ottawa where pain physicians were
We do believe increasing awareness of the opioid overdose risk is appropriate, but claiming
certain unsubstantiated tisks outweigh the benefits of using opioids to treat pain lacks scientific
foundation. According to a recent study by Dasgupta et al., of 2,181,372 patients prescribed
opioids, 478 deaths were reported (0.022% per year). In addition the CDC Guidelines, which
these are based on, are in direct conflict with the National Institutes of Health guidelines put out
in 2014. They were based on an extensive literature review by an unbiased expert panel which
concluded: “What was particularly striking to the panel was a realization that there is
insufficient evidence for every clinical decision that a provider needs to make regarding the use
of opioids for chronic pain, leaving the provider to rely on his or her own clinical experience.” It
was also observed the target should be what the patient and their healthcare provider have
decided between themselves as a reasonable goal to accomplish.
Pain patients feel strongly the authors and policy makers behind these guidelines have missed
another golden opportunity to create real change in this area of medicine. They would have
impacted pain medicine far more positively if they had used their resources and ability to bring a
strong group together to develop forward thinking educational programs and incorporate them
into the curricula in our teaching hospitals. This would have a far greater impact on addressing
the chronic pain pandemic and that of addictions. By putting forth guidelines like this, at this
time, to influence a profession that has little education and understanding about chronic pain is
myopic and similar to the last attempt at guidelines will simply encourage more physicians to
dump the pain patients they now have.
Or is that the goal?
Barry D. Ulmer
The Chronic Pain Association of Canada
11247 11 Avenue NW