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Supporting safe opioid practices: The Comox Valley Safe Opioid Prescribing Algorithm

The Comox Valley division has partnered with community representatives and local RCMP to establish a standardized approach to safe opioid practices in the community. This work includes the creation of the division’s Safe Opioid Algorithm, and a presentation by Dr Charuka Maheswaran-Moeller that was featured on an episode of Where We All Belong, a 14-episode series created by the Courtenay Drug Strategy Committee in collaboration with Shaw Community Television.  

The Safe Opioid Prescribing Algorithm aims to help ensure that opioid medications are used only as prescribed. The algorithm walks doctors through a process that involves performing a baseline assessment of a patient’s pain issues, reviewing alternative pain management strategies with the patient, and re-assessing the patient to determine whether an alternative pain management strategy has been effective. If no alternative strategies are effective, the algorithm leads doctors to the next steps of creating an opioid treatment agreement with the patient (which is then shared with the pharmacist), trialing opioid therapy, follow-up, and a re-assessment of goals. If the patient’s pain issues are still not being addressed, or if opioids are not being used as prescribed, the algorithm lays out a process for referring to a specialist or employing an exit strategy from opioid treatment, which can include discussing consequences with the patient and reporting aberrant behaviour.

The division has also created a set of resources and tools to accompany the Safe Opioid Prescribing Algorithm. The Comox Valley Safe Opioid Prescribing Algorithm Resources & Tools is a comprehensive document that includes:

Patient resources​:

  • Local pain management resources
  • Regional pain management resources
  • Online pain management resources
  • Videos
  • Smartphone/tablet apps
  • Goals and hazards of opioid therapy
  • How to safely take opioids
  • Stopping opioids
Physician resources​:
  • Referral forms
  • Opioid treatment agreement
  • Tips and requisitions for random urine drug screening
  • Support for withdrawal and wean-down management
  • Sample opioid misuse letter from RCMP
  • Additional tools and resources from the GPSC Chronic Pain Algorithm (available in fillable PDF format through PSP)
Comox’s chronic pain and opioid prescribing resources are available along with other division-created resources on the Pain Management and Opioid Prescribing page on the divisions website.

To learn more about Comox Valley division’s work on safe opioid practices, visit


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