Current evidence suggests that medium and long-term opioid use in people with chronic non-cancer pain may not be generally beneficial, that risks may outweigh benefits, and that it may, in fact, in some cases be harmful or even lethal. The routine clinical use of opioids, especially at high dose, for chronic non-cancer pain has therefore in the recent past attracted significant skepticism in the scientific community as well as among practitioners. We propose to write a Cochrane overview that investigates adverse events occurring with medium and long-term opioid use for chronic non-cancer pain, to inform current understanding and future evidence-based decision-making. This overview will be a systematic review of Cochrane systematic reviews that investigate such opioid use.
Our overview will describe the adverse events occurring: with medium and long-term therapeutic opioid use, when opioids are in the high dose range, with different durations of opioid use, with opioid naïve patients; and will examine differences in the adverse event profile when: oral vs. transdermal products are used, combination drugs vs. single agent opioid drugs are used, abuse-deterrent vs. other formulations are used. It will also examine differences in the adverse event profile occurring along gender, age, or ethnicity axes. The overview will also discover commonly used inclusion/exclusion criteria, as well as under- or over-representation biases, and how these influence the generalizability of findings to the clinical setting and the WCB population.
We believe this topic to be of interest to WCB-Alberta because of the significant number of WCB claimants who receive opioids for chronic non-cancer pain. The WCB-Alberta’s Mandate and Roles document calls for evidence-based decision making. Evidence syntheses as provided by the overview we will conduct here can form the basis of such evidence-based decision making on the part of WCB-Alberta staff and consultants.