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We wish to respond to the commentary of Dr. Persaud [1] regarding the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain [2].
Dr. Persaud takes our statement regarding controlled release versus short acting opioids out of context. The full statement is as follows:
“In patients with continuous pain including pain at rest, clinicians can prescribe controlled release opioids both for comfort and simplicity of treatment. Activity related pain may not require sustained release treatment and opioid therapy may be initiated with immediate release alone.
The benefit and safety of controlled release or sustained release over immediate release preparations is not clearly established. Some patients, when switching from immediate release to comparable dose sustained release, require larger doses in order to acquire a similar analgesic effect. The release profile of all sustained or controlled release preparations is not the same and may vary for the same drug among patients. Individuals misusing opioids favour immediate release opioid preparations, regardless of the route of administration.[3]”Regarding the last point, a structured survey of 8304 individuals entering treatment for opioid use disorder found that only 4% selected extended release opioids as their preferred formulation, while 66% favoured short acting opioids; the remainder (30%) had no preference.
Dr. Persaud suggests that differences between the Canadian Guideline and th...
Show MoreCompeting Interests: All authors were members of the Steering Committee for the Canadian opioid guideline. David Juurlink was a member of the Stakeholder Review Group for the CDC Guideline for Prescribing Opioids for Chronic Pain. D. Norm Buckley reports grants from Purdue Pharma and Janssen Inc. outside the submitted work.
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