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New consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain management

New consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain management

An analysis by the United Nations Office on Drugs and Crime (UNODC) in 2016 reported that Canada had the highest consumption of opioids per capita in the world.

In order to understand the pattern and trend of prescribing opioids in Canada, CIHI's (Canadian Institute for Health Information) scientists analyzed data from the National Prescription Drug Utilization Information System (NPDUIS) and Ontario’s Narcotics Monitoring System (NMS). It found that only 27.3% of patients tried non-opioid analgesics before starting opioid therapy in 2018.

An analysis by the Canadian "Opioid Overdose Surveillance Task Group" (OOSTG) reported that:

  • 3,823 Canadians died because of opioid overdose in 2019.
  • 94% of death was unintentional, and in 77% of cases, fentanyl or its analogs were involved.
  • In 1 in 5 deaths, only pharmaceutical opioids were involved.
  • In 2019, there were 19,377 hospitalizations due to opioid poisoning.
  • Patients over the age of 60, was the largest age group hospitalized for opioid poisoning (29%).

New consensus recommendations:

There have been recent efforts to manage this crisis globally, and the recent consensus-based recommendations can be a new tool for practitioners to improve the quality of life of patients suffering from chronic pain. The authors used a  five-step modified Delphi process to develop consensus-based recommendations on: 

  • When and how to safely initiate and titrate cannabinoids in the presence of opioids
  • When and how to safely taper opioids in the presence of cannabinoids
  • How to monitor patients and evaluate outcomes when treating with opioids and cannabinoids.



  1. UNITED NATIONS. Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes, New York, NY: UN; 2016.
  2. Canadian Institute for Health Information. Opioid Prescribing in Canada: How Are Practices Changing?. Ottawa, ON: CIHI; 2019.
  3. Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid-related Harms in Canada. Ottawa: Public Health Agency of Canada; June 2020.
  4. Sihota A, Smith BK, Ahmed SA, Bell A, Blain A, Clarke H, Cooper ZD, Cyr C, Daeninck P, Deshpande A, Ethans K, Flusk D, Le Foll B, Milloy MJ, Moulin DE, Naidoo V, Ong M, Perez J, Rod K, Sealey R, Sulak D, Walsh Z, O'Connell C. Consensus-Based Recommendations for Titrating Cannabinoids and Tapering Opioids for Chronic Pain Control. Int J Clin Pract. 2020 Nov 28:e13871. doi: 10.1111/ijcp.13871. Epub ahead of print. PMID: 33249713.

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