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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
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 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 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
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
- 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.
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