What essential elements should be obtained in Canada before prescribing opioids?

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Before prescribing opioids in Canada, you need a plan that emphasizes safety and ongoing oversight. This includes a risk assessment for misuse, obtaining informed consent that covers the risks, benefits, and alternatives, obtaining the patient’s agreement on safe storage and disposal of the medication, and arranging appropriate follow-up to monitor efficacy, safety, and potential misuse. Where available, use drug monitoring programs to check prescription history and detect problematic patterns.

These elements help identify patients at higher risk for misuse, ensure the patient understands the treatment's risks and alternatives, reduce the chance of diversion through proper storage and disposal, and allow timely adjustments or discontinuation if the risks outweigh the benefits. Omitting any of these steps—risk assessment, informed consent, storage/disposal planning, or follow-up—undermines safety and appropriate use.