Effects of practice standards on opioid prescribing and chronic pain management

In an effort to curb misuse of opioids and prevent overdose deaths, the College of Physicians and Surgeons of British Columbia released a legally enforceable practice standard, Safe Prescribing of Drugs with Potential for Misuse/Diversion, in 2016. This document limited prescribing of opioids for chronic noncancer pain (CNCP) with specific prescribing practices that clinicians were obligated to follow.

In research that tested the effects of the 2016 practice standard on prescribing to patients with CNCP, researchers found that its introduction had a marked impact on prescribing practices. Pre-existing declining trends in doses of opioids (measured in morphine milligram equivalents) accelerated, as did declines in high-dose prescribing, coprescribing with hypnotics like benzodiazepines, and prescribing larger supplies of medications. As well, the number of patients who had doses aggressively tapered increased, which can result in improper pain management. The analysis included data on all opioid prescriptions dispensed to community-living adults in BC between October 2012 and March 2020.

"This demonstrates the ability of practice standards to modify physician behavior but also highlights how misinterpretation can harm patients," writes Dr. Dimitra Panagiotoglou, associate professor at McGill University, Montréal, Quebec, with coauthors. "Patient groups and physicians affected by standards or guidelines should be consulted before their release to reduce unintended consequences."

When the 2016 practice standard was replaced in 2018, the downward trends slowed.

"These findings demonstrate that prescribing guidelines and practice standards can have immediate and long-lasting effects on physician prescribing. Although most of the changes may be positive (e.g., fewer opioids in the community, a reduction in coprescribed benzodiazepine), incorrect interpretation can increase harms for some patients. Aggressive tapering can have downstream consequences, including people resorting to unregulated opioids for pain relief despite their risks," write the authors.

People living with chronic pain and opioid use disorder (OUD) in Canada are often unable to access evidence-based treatment, which can reduce effectiveness of treatments for OUD, according to a commentary in the same issue.

"Overcoming barriers - such as siloed care for OUD and chronic pain, and restricted access to allied health services that can improve pain management and OUD outcomes - is essential to effectively addressing the needs of patients with comorbid OUD and chronic pain," writes Dr. Kiran Grant, an emergency medicine resident at the University of British Columbia, Vancouver, BC, with coauthors.

They suggest interdisciplinary approaches, such as including pain management specialists in care, could help improve outcomes for people with chronic pain and OUD.

"The effects of a provincial opioid prescribing standard on opioid prescribing for pain in adults: an interrupted time-series analysis" and "Integrating chronic pain management into care for patients with opioid use disorder" are published May 12, 2025.