Quality Standard Details
Opioid Prescribing for Chronic Pain: Care for People 15 Years of Age and Older
- Publication Date
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2018-March-01
- Status
- Published
- Topic Area
- Pain
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Chronic pain is often defined as pain that lasts longer than three months or past the time of normal tissue healing, and has been estimated to affect one in five Canadians. In Ontario, opioids are often prescribed to manage chronic pain, but opioid therapy can present a considerable risk of harm for what may be only a short-term benefit for some people.
In 2015/16, more than nine million opioid prescriptions were written in Ontario, and 1.94 million Ontarians were dispensed opioids. This rate of opioid consumption is very high by global standards. There is also a remarkable level of unexplained regional variation in the use of opioids across Ontario, with the percentage of people prescribed opioids for pain ranging from 11% to 18% across regions.
Evidence suggests that a multimodal combination of non-opioid therapies, delivered through a multidisciplinary approach, can often be as effective as opioids in managing chronic pain while presenting far less risk of harm. Family physicians and nurse practitioners practising in primary care play a crucial role in supporting effective chronic pain management for patients.
This quality standard provides guidance on the prescribing, monitoring, and tapering of opioids to treat chronic pain for people 15 years of age and older in all care settings. It does not address opioid prescribing for acute pain or end-of-life care, nor does it address the management of opioid use disorder in depth.
Please refer to our Opioid Prescribing for Acute Pain quality standard and Opioid Use Disorder quality standard for detailed quality statements related to these topics.
Quality Standard in Brief
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Quality Statement 1: Comprehensive Assessment
People with chronic pain receive a comprehensive assessment, including consideration of their functional status and social determinants of health.
Quality Statement 2: Setting Goals for Pain Management and Function
People with chronic pain set goals for pain management and functional improvement in partnership with their health care professionals. These goals are evaluated regularly.
Quality Statement 3: First-Line Treatment With Non-Opioid Therapies
People with chronic pain receive an individualized and multidisciplinary approach to their care. They are offered non-opioid pharmacotherapy and nonpharmacological therapies as first-line treatment.
Quality Statement 4: Shared Decision-Making and Information on the Potential Benefits and Harms of Opioids for Chronic Pain
People with chronic pain, and their families and caregivers receive information about the potential benefits and harms of opioid therapy for chronic pain at the time of both prescribing and dispensing so that they can participate in shared decision-making.
Quality Statement 5: Initiating a Trial of Opioids for Chronic Pain
People with chronic pain begin a trial of opioid therapy only after other multimodal therapies have been tried without adequate improvement in pain and function, and they either have no contraindications to opioid therapy or have discussed any relative contraindications with their health care professional.
If opioids are initiated, the trial starts at the lowest effective dose, preferably below 50 mg morphine equivalents per day. Titrating over time to a dose of less than 90 mg morphine equivalents per day may be warranted in selected cases in which people are willing to accept a higher risk of harm for an improved pain relief.
Quality Statement 6: Co-prescribing Opioids and Benzodiazepines
People with chronic pain are not prescribed opioids and benzodiazepines at the same time whenever possible.
Quality Statement 7: Opioid Use Disorder
People prescribed opioids for chronic pain who are subsequently diagnosed with opioid use disorder have access to opioid agonist therapy.
Quality Statement 8: Prescription Monitoring Systems
Health care professionals who prescribe or dispense opioids have access to a real-time prescription monitoring system at the point of care. Prescription history is checked when opioids are prescribed and dispensed and every 3-6 months during long-term use, or more frequently if there are concerns regarding duplicate prescriptions, potentially harmful medication interactions, or diversion.
Quality Statement 9: Tapering and Discontinuation
All people with chronic pain on long-term opioid therapy, especially those taking 90 mg morphine equivalents or more per day, are periodically offered a trial of tapering to a lower dose or tapering to discontinuation.
Quality Statement 10: Health Care Professional Education
Health care professionals have the knowledge and skills to appropriately assess and treat chronic pain using a multidisciplinary, multimodal approach; appropriately prescribe, monitor, taper, and discontinue opioids; and recognize and treat opioid use disorder.
Supporting Documents
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Patient guide for this quality standard
Know what to ask for in your care
Placemat for this quality standard
A quick-reference resource for clinicians that summarizes the quality standard and includes links to helpful resources and tools
Quality improvement tools and resources for health care professionals, including an action plan template
Supplementary information to support the data collection and measurement process
Additional Resources
If you would like to receive these resources, please send us a message using our contact form:
- Case for improvement (slide deck)
Share why this standard was created and the data behind it, to get the support you need to put it into practice - Technical specifications
See the technical specifications for the indicators within the quality standard - Tools to support patient care
- Summary of the public feedback we received
- Case for improvement (slide deck)
Last Updated: February 24, 2026
