title: Self-reported practices in opioid management of chronic noncancer pain: a survey of Canadian family physicians.
abstract: BACKGROUND
  In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians' (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated.
  
  
  OBJECTIVE
  To determine FPs' practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP.
  
  
  METHODS
  An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges.
  
  
  RESULTS
  A total of 710 responses were received. FPs followed a precautionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug-related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the 'watchful dose' of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient's opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse.
  
  
  CONCLUSIONS
  While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs.
authors.affiliation: Department of Community Health and Epidemiology, Anesthesia, Dalhousie University, Nova Scotia. michael.allen@dal.ca
authors.forename: Michael John Maynard
authors.initials: MJ
authors.lastname: Allen
authors.forename: Mark M
authors.initials: MM
authors.lastname: Asbridge
authors.forename: Peter C
authors.initials: PC
authors.lastname: Macdougall
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Furlan
authors.forename: Oleg
authors.initials: O
authors.lastname: Tugalev
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002170:Canada / Q000453:epidemiology; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010821:Physicians, Family
chemical_list: D000701:Analgesics, Opioid