Browse by Category

Welcome to the Evidence Bundle for opioids.

Here you will find our best evidence related to opioids arranged under the following categories:

• Pain Treatment
• Misuse/Abuse, Overdose, Harms
• Opioid Use Disorder/Addiction Treatment
• Alternatives to Opioids

Pain Treatment

• Opioids for the Treatment of Pain (Mind the Research Gaps Tool, September 2018)
• Timing of Fentanyl Patch Re-Application: Clinical Effectiveness and Guidelines (Summary of Abstracts, May 2018)
• Antidepressants for Adults with Depression using Opioid Medications: Clinical Effectiveness and Guidelines (Summary of Abstracts, February 2018)
• Opioids for pain after surgery: Your questions answered (Tool from ISMP Canada, February 2018)
• 2017 Canadian Guideline for Opioids for Chronic Pain (Guidelines from the Michael G. DeGroote National Pain Centre at McMaster University and funded by Health Canada and the Canadian Institutes of Health Research, May 2017)
• Strategies for the Reduction or Discontinuation of Opioids: Guidelines (Summary of Abstracts, April 2017)
• Navigating Opioids for Chronic Pain (Infographic, 2017)
• Buprenorphine for Chronic Pain: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, January 2017)
• Medications for the Management of Post-Surgical Pain in Pediatrics: Guidelines (Summary of Abstracts, July 2016)
• Pain Management for Women, Aboriginal Peoples, or the Elderly: Guidelines (Summary of Abstracts, March 2016)
• Combination Benzodiazepine-Opioid Use: Clinical Evidence and Guidelines (Reference List, March 2015)
• Tramadol for the Management of Pain in Adult Patients: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, February 2015)
• Slow-Release Opioids for Postoperative Pain: Clinical Effectiveness (Summary of Abstracts, November 2014)
• Pentazocine versus Short-acting Opioids for Chronic or Acute Pain: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, May 2013)
• Opioids for Chronic Pain newsletter (overview of themes and resources, April 2013)
• Codeine Compared with Other Opioids for Pain Relief in Pediatric Patients: Comparative Clinical Effectiveness, Safety, and Guidelines (Summary of Abstracts, February 2013)
• Suboxone for the Treatment of Chronic Non-Cancer Pain: Clinical Effectiveness and Guidelines (Summary of Abstracts, January 2013)
• Optimal Pain Management Following Tonsillectomy or Adenoidectomy for Pediatric Patients: Clinical Evidence and Guidelines (Summary of Abstracts, December 2012)
• Optimal Post-Tonsillectomy Pain Management for Pediatric Patients: Clinical Evidence and Guidelines (Summary of Abstracts, October 2012)
• Opioid Trial Periods in the Treatment of Chronic Non-Cancer Pain: A Review of the Clinical Evidence (Summary With Critical Appraisal, June 2012)
• Watchful Dosing of Morphine in the Treatment of Chronic Non-Cancer Pain: A Review of the Clinical Evidence (Summary With Critical Appraisal, June 2012)
• Evaluation of Opioid Use for Patients with Chronic Non-Cancer Pain: Clinical Evidence (Reference List, June 2012)
• Fentanyl Citrate (Onsolis) for Breakthrough Cancer Pain (Adults) (Drug Reimbursement Recommendation, February 2012)
• Mucosal Atomization Devices for the Administration of Pain Medications: Clinical Effectiveness, Safety, and Guidelines (Reference List, January 2012)
• Fentanyl Citrate (Abstral) for Breakthrough Cancer Pain (Drug Reimbursement Recommendation, June 2011)
• Buprenorphine Transdermal Patch (BuTrans) for Persistent Pain (Moderate Intensity) (Drug Reimbursement Recommendation, May 2011)
• Tapentadol (Nucynta CR) for Moderate to Moderately Severe Pain (Drug Reimbursement Recommendation, February 2011)

Misuse/Abuse, Overdose, Harms

• Policies to Reduce Harms from the Concomitant Use of Opioids and Central Nervous System Depressant Drugs (Environmental Scan, July 2018)
• Funding and Management of Naloxone Programs in Canada (Environmental Scan, March 2018)
• The Diagnosis and Treatment of Neonatal Abstinence Syndrome: Clinical Effectiveness and Guidelines (Summary of Abstracts, April 2017)
• Strategies for the Reduction or Discontinuation of Opioids: Guidelines (Summary of Abstracts, April 2017)
• Intranasal and Intramuscular Naloxone for Opioid Overdose in the Pre-Hospital Setting: A Review of Comparative Clinical and Cost-Effectiveness, and Guidelines (Summary with Critical Appraisal, March 2017)
• Opioid Formulations With Tamper-Resistance or Abuse-Deterrent Features — Products and Policies (Environmental Scan, March 2017)
• Navigating Opioids for Chronic Pain (Infographic, 2017)
• Unused Medication Disposal Programs: Clinical Utility and Guidelines (Reference List, April 2016)
• Crushed Buprenorphine or Buprenorphine-Naloxone for Opioid Dependency: A Review of the Clinical Effectiveness and Guidelines (Summary With Critical Appraisal, July 2016)
• Prescribing and Dispensing Policies to Address Harms Associated With Prescription Drug Abuse (Environmental Scan, October 2015)
• Education and Assessment for Overdose Prevention: A Review of the Clinical Evidence and Guidelines (Summary With Critical Appraisal, September 2015)
• Secure Prescription Pads for Prescribing of Medications Prone to Abuse and Misuse: Clinical Effectiveness, Cost-Effectiveness and Guidelines (Reference List, July 2015)
• The Use of Transdermal Buprenorphine in Adults: Safety (Reference List, July 2015)
• Tamper-Resistant Oxycodone: A Review of the Clinical Evidence and Cost-effectiveness (Summary With Critical Appraisal, June 2015)
• Narcotics, Benzodiazepines, Stimulants, and Gabapentin: Policies, Initiatives, and Practices Across Canada, 2014 (Environmental Scan, October 2014)
• Policies to Expand Naloxone Availability: A Review of the Clinical Effectiveness (Reference List, September 2014)
• Administration of Naloxone in a Home or Community Setting: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines (Summary With Critical Appraisal, June 2014)
• Stepwise Approach for the Prescription of Opiates for Non-Cancer Pain: A Review of Clinical Evidence and Guidelines (Summary With Critical Appraisal, May 2014)
• Watchful Dosing of Morphine in the Treatment of Chronic Non-Cancer Pain: A Review of the Clinical Evidence (Summary With Critical Appraisal, June 2012)
• Opioid Management Practices for the Prevention of Drug Diversion and Misuse: A Review of the Clinical Evidence and Guidelines (Summary With Critical Appraisal, April 2012)
• Prevention Strategies for Substance Misuse Harm Reduction: A Review of Clinical Evidence (Summary With Critical Appraisal, January 2012)
• The Use of OxyNEO and OxyContin in Adults: A Review of the Evidence on Safety (Summary With Critical Appraisal, September 2011)

Opioid Use Disorder/Addiction Treatment

• e-Therapy Interventions for the Treatments of Substance Use Disorders and Other Addictions: A Review of Clinical Effectiveness (Summary With Critical Appraisal, June 2018)
• Buprenorphine Formulations for the Treatment of Opioid Use Disorders: Comparative Clinical Effectiveness, Cost-Effectiveness, and Guidelines(Reference List, April 2018)
• Metadol Liquid, Methadose, and Compounded Methadone in Patients Using Opioid Agonist Therapy: Comparative Clinical Effectiveness and Guidelines(Summary of Abstracts, April 2018)
• Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness and Guidelines (Summary with Critical Appraisal, February 2018)
• Antidepressants for Adults with Depression using Opioid Medications: Clinical Effectiveness and Guidelines (Summary of Abstracts, February 2018)
• Concurrent Treatment for Substance Use Disorder and Trauma-Related Comorbidities: A Review of Clinical Effectiveness and Guidelines (Summary with Critical Appraisal, August 2017)
• Injectable Extended-Release Naltrexone to Treat Opioid Use Disorder (Horizon Scan, August 2017)
• Buprenorphine Formulations for the Treatment of Opioid Use Disorders: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines (Summary with Critical Appraisal, July 2017)
• Occupational Therapy Interventions to Prevent Opioid Relapse: Clinical and Cost-Effectiveness and Guidelines (Summary of Abstracts, July 2017)
• Naltrexone for Opioid Use Disorders: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines (Summary with Critical Appraisal, July 2017)
• Drug Testing for Patients with Substance Use Disorder: Clinical Effectiveness and Guidelines (Summary of Abstracts, June 2017)
• The Use of Transdermal Buprenorphine Patches in Aiding in Opioid Withdrawal: Clinical Effectiveness and Guidelines (Reference List, June 2017)
• The Diagnosis and Treatment of Neonatal Abstinence Syndrome: Clinical Effectiveness and Guidelines (Summary of Abstracts, April 2017)
• Sustained Release Oral Morphine, Injectable Hydromorphone, and Prescription Diacetylmorphine for Opioid Use Disorder: Clinical and Cost-Effectiveness, and Guidelines (Summary of Abstracts, April 2017)
• Medical Cannabis in Residential Transition or Addiction Programs: A Review of Clinical and Cost-Effectiveness and Guidelines (Summary with Critical Appraisal, April 2017)
• Pharmacological options for treating opioid addiction (Hospital News Article, April 2017)
• Buprenorphine Implant for the Treatment of Opioid Use Disorder (Horizon Scan, March 2017)
• Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines (Peer-Reviewed Summary With Critical Appraisal, September 2016)
• Rapid and Ultra-Rapid Detoxification in Adults with Opioid Addiction: A Review of Clinical- and Cost-Effectiveness, Safety, and Guidelines (Summary With Critical Appraisal, January 2016)
• Optimal Evidence-Based Therapies for the Treatment of Addictions: Clinical Effectiveness and Guidelines (Summary of Abstracts, January 2016)
• Mindfulness Interventions for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Use Disorders: A Review of the Clinical Effectiveness and Guidelines (Summary With Critical Appraisal, June 2015)
• Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines (Summary With Critical Appraisal, June 2015)
• Team-Based Behavioural Support for Youth Experiencing Mental Health or Addiction Issues: Clinical Effectiveness and Guidelines (Summary of Abstracts, January 2015)
• Suboxone Versus Methadone for the Detoxification of Patients Addicted to Prescription Opioids: A Review of Comparative Clinical Effectiveness, Safety, and Guidelines (Summary With Critical Appraisal, February 2014)
• Buprenorphine/Naloxone (Suboxone) Film versus Buprenorphine/Naloxone Tablets for the Treatment of Opioid Addiction: Comparative Safety (Summary of Abstracts, January 2014)
• Suboxone Versus Methadone for the Treatment of Opioid Dependence: A Review of the Clinical and Cost-effectiveness (Summary With Critical Appraisal, November 2013)
• Treatment for Opioid Dependence: A Review of Guidelines (Summary With Critical Appraisal, September 2012)

Alternatives to Opioids

• Analgesics for Surgical Third Molar Extraction: Clinical Effectiveness and Guidelines (Summary of Abstracts, April 2018)
• Gabapentin for Adults with Neuropathic Pain: A Review of the Clinical Effectiveness (Summary with Critical Appraisal, March 2018)
• Emerging Non-Opioid Drugs for the Treatment of Pain (Environmental Scan, February 2018)
• Botulinum Toxin A for Chronic Migraines: Clinical Effectiveness (Summary of Abstracts, January 2018)
• Intranasal Sufentanil for Acute Pain: Clinical Effectiveness and Guidelines (Summary of Abstracts, December 2017)
• Exercise for the Management of Knee Osteoarthritis: A Review of Clinical Effectiveness (Summary with Critical Appraisal, August 2017)
• Manual Therapy for the Recent-Onset or Persistent Neck Pain: A Review of Clinical Effectiveness and Guidelines (Summary with Critical Appraisal, August 2017)
• Physiotherapy Interventions for the Management of Neck or Back Pain: Cost-Effectiveness (Summary of Abstracts, August 2017)
• Nabilone for Chronic Pain Management: A Review of Clinical Effectiveness and Guidelines (Summary with Critical Appraisal, August 2017)
• Virtual Reality or Gaming Applications for Pain Management or Distraction: Clinical Effectiveness and Guidelines (Reference List, August 2017)
• Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach: A Review of the Clinical and Cost-Effectiveness and Guidelines (Summary with Critical Appraisal, August 2017)
• Exercise for the Management of Back Pain: Clinical Effectiveness (Summary of Abstracts, August 2017)
• Manual Therapy for Recent-Onset or Persistent Non-Specific Lower Back Pain: A Review of Clinical Effectiveness and Guidelines (Summary with Critical Appraisal, August 2017)
• Gabapentin, Celecoxib, and Acetaminophen for the Prevention of Post-Operative Pain: Clinical Effectiveness (Summary of Abstracts, July 2017)
• Exercise for the Management of Neck Pain: Clinical Effectiveness (Summary of Abstracts, July 2017)
• Pre-Operative Naproxen for Gynecological Surgery: Clinical Effectiveness (Summary of Abstracts, July 2017)
• Exercise for the Management of Fibromyalgia: Clinical Effectiveness (Summary of Abstracts, July 2017)
• Manual Therapy for the Treatment of Shoulder Pain: Clinical Effectiveness (Reference List, July 2017)
• Manual Therapy for the Treatment of Cervicogenic Headaches: Clinical Effectiveness (Reference List, July 2017)
• Physiotherapy Interventions for the Management of Neck and/or Back Pain: A Review of Clinical and Cost-Effectiveness (Summary with Critical Appraisal, June 2017)
• Splinting to Reduce Upper Extremity Pain: Clinical and Cost-Effectiveness and Guidelines (Summary of Abstracts, June 2017)
• Viscosupplementation for Knee Osteoarthritis: A Review of Clinical and Cost-Effectiveness and Guidelines (Summary with Critical Appraisal, June 2017)
• Multidisciplinary Treatment Programs for Patients with Chronic Non-Malignant Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines (Summary with Critical Appraisal, June 2017)
• Physiotherapy Interventions for the Management of Fibromyalgia: Clinical and Cost Effectiveness (Summary of Abstracts, June 2017)
• Low-Dose Naltrexone for Chronic Non-Cancer Pain: Clinical Effectiveness (Summary of Abstracts, June 2017)
• Medical Cannabis Evidence Bundle (Evidence Bundle, May 2017)
• The Use of Medical Cannabis with Other Medications: A Review of Safety and Guidelines (Summary with Critical Appraisal, April 2017)
• Magnesium as an Alternative or Adjunct to Opioids for Chronic Pain: A Review of the Clinical Effectiveness and Guidelines (Summary with Critical Appraisal, April 2017)
• If not opioids, then what? (Hospital News Article, March 2017)
• Pregabalin for Acute Pain: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, January 2017)
• Ketorolac versus Non-Steroidal Anti-Inflammatory Drugs for the Management of Acute Pain: Comparative Clinical Effectiveness (Summary of Abstracts, January 2017)
• Topical NSAIDs Versus Opioids for Acute Musculoskeletal Pain: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, January 2017)
• Ibuprofen 600 mg or 800 mg for Acute Pain: Clinical Effectiveness (Reference List, December 2016)
• Injectable Non-Opioid Pain Relievers for Acute Pain in the Pre-Hospital Setting: Clinical Effectiveness and Guidelines (Summary of Abstracts, December 2016)
• Self-Management Interventions for Back Pain: Clinical Effectiveness and Guidelines (Reference List, December 2016)
• Behavioural and Psychological Interventions for Chronic Non-Cancer Pain: A Review of Guidelines (Summary With Critical Appraisal, November 2016)
• Home Transcutaneous Electrical Nerve Stimulation for Chronic Pain: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, December 2016)
• Physical Therapy Treatments for Chronic Non-Cancer Pain: A Review of Guidelines (Summary With Critical Appraisal, November 2016)
• Pharmacological Interventions for Back Pain: Clinical Effectiveness and Guidelines (Reference List, November 2016)
• Acetaminophen for Pain or Fever: Clinical Effectiveness and Safety (Reference List, September 2016)
• 1000 mg versus 650 mg Acetaminophen for Pain or Fever: A Review of the Clinical Efficacy (Summary With Critical Appraisal, June 2016)
• Tramadol Plus Acetaminophen for the Management of Pain in Adult Patients: Clinical Effectiveness (Summary of Abstracts, November 2015)
• Long-term Use of Cyclobenzaprine for Pain: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, February 2015)
• Tramadol for the Management of Pain in Adult Patients: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, February 2015)
• Prolotherapy for the Management of Musculoskeletal Pain: A Review of the Clinical Effectiveness (Summary With Critical Appraisal, November 2014)
• Gabapentin for Adults with Neuropathic Pain: A Review of the Clinical Evidence and Guidelines (Summary With Critical Appraisal, September 2014)
• Platelet Rich Plasma Lumbar Disc Injections for Lower Back Pain: Clinical Effectiveness, Safety, and Guidelines (Summary With Critical Appraisal, February 2014)
• Non-Drug Interventions for Chronic Non-Cancer Pain: Guidelines and Recommendations (Reference List, February 2014)
• Non-steroidal Anti-inflammatory Drugs for Pain: A Review of Safety (Summary With Critical Appraisal, August 2013)
• Non-steroidal Anti-inflammatory Drugs for Pain: Comparative Clinical and Cost-Effectiveness (Reference List, July 2013)
• Intravenous Ketamine for the Treatment of Pain Syndromes: Clinical Effectiveness (Summary of Abstracts, June 2013)
• Intrathecal Bupivacaine via Infusion Pump for the Management of Pain: Clinical Evidence, Safety, and Guidelines (Summary of Abstracts, November 2012)
• Codeine and Acetaminophen for Pain Relief: A Review of the Clinical Efficacy and Safety (Summary With Critical Appraisal, April 2012)
• Mindfulness Training for Chronic Pain Management: A Review of the Clinical Evidence and Guidelines (Summary With Critical Appraisal, January 2012)
• Multidisciplinary Treatment Programs for Patients with Non-Malignant Pain: A Review of the Clinical Evidence, Cost-Effectiveness, and Guidelines (Summary With Critical Appraisal, November 2011)