Opioid Prescribing Safety Measures Utilized by Primary Healthcare Providers in Canada: A Scoping Review

Background: Opioid-related hospitalizations, emergency department visits, and mortality due to opioid poisoning have risen across Canada. The high use of opioids warrants the examination of safety measures used by primary healthcare providers (PHCPs). Objective: To identify and synthesize the opioid prescribing safety measures literature to determine the extent, range, and nature of literature available regarding the safety measures utilized by PHCPs when prescribing opioids in Canada. Methods: Two independent researchers conducted a scoping review to determine the extent, range, and nature of literature available regarding the safety measures utilized by PHCPs when prescribing opioids in Canada. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs institute Reviewers' Manual were used to guide the review. Results: All sources reviewed physician prescribing practices; none of the literature concerned nurse practitioner opioid prescribing. Four themes emerged: (a) inadequate physician knowledge and education regarding opioid prescribing for chronic noncancer pain, (b) challenge of prescribing opioids, (c) improper funding structure and time for complex patient assessments, and (d) lack of emergency department guidelines. Conclusion: Undertaking the issues of chronic noncancer pain and the opioid crisis will require a multifaceted approach that includes increased pain management education, community support and services, review of institutional practices, and increased funding in the area of pain research.