Table 3.
Barriers and facilitators to implementation of the 2017 Canadian opioid guideline.
| Implementation challenges (n = 590), n (%)1 | |
| Reluctance by patients | 388 (66%) |
| Financial barriers to nonpharmacologic treatment alternatives | 374 (63%) |
| Lack of nonpharmacologic treatment alternatives | 371 (63%) |
| Inadequate time to deal with complex cases | 273 (46%) |
| Lack of access to addiction management services | 266 (45%) |
| Unrealistic to taper some high-dose legacy patients to <90 mg MED | 243 (41%) |
| Lack of access to specialists for support | 218 (37%) |
| Financial barriers to addiction management services | 189 (32%) |
| Need better training in chronic pain management | 127 (22%) |
| Need more training in chronic pain management | 118 (20%) |
| Need better training in addiction management | 114 (19%) |
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| |
| Implementation facilitators (n = 590), n (%)1 | |
| More chronic pain treatment options covered by insurance | 353 (60%) |
| Greater availability of chronic pain treatment services | 323 (55%) |
| Billing incentives to spend more time with chronic pain patients | 235 (40%) |
| Greater availability of addiction treatment services | 221 (38%) |
| Continuing medical education on opioid deprescribing | 202 (34%) |
| Continuing medical education on nonopioid management of chronic pain | 180 (31%) |
| Real-time access to a prescription monitoring database | 153 (26%) |
| Access to treatment to support behavioral change | 126 (21%) |
| Clinical decision support system integrated into EMRs | 116 (20%) |
| Access to support, such as self-assessments, checklists, and algorithms | 120 (20%) |
| Continuing medical education on opioid prescribing | 109 (19%) |
| Mentorship programs in chronic noncancer pain and addiction | 90 (15%) |
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| |
| Continuing medical education topics of interest (n = 590), n (%)2 | |
| Managing demanding, resistant, or nonadherent patients on chronic opioids | 339 (58%) |
| Nonopioid options for chronic noncancer pain management | 262 (44%) |
| Strategies to safely taper opioids | 209 (35%) |
| Initiating opioid substitution therapy | 190 (32%) |
| Community programs to reduce opioid addiction and deaths | 117 (20%) |
| Screening, initiating, and monitoring patients on opioid therapy | 106 (18%) |
| Preventing and managing opioid overdoses | 38 (6%) |
1Percentages add up to >100% as respondents could endorse more than one option. 2Percentages add up to >100% as respondents could endorse up to 3 options. EMRs: electronic medical records.