First, do no harm: Advocating for opioid prescribing guidelines in Canadian emergency departments.

The excessive use of prescription opioids, where avoidable, is a major health concern for individual communities and for all of Canada. Globally, Canada is the leader in per-capita prescription opioid consump-tion, with approximately 360,000 individuals dependent on prescription opioids. 1,2 In 2015, more Canadians were dependent on prescription opioids than were diagnosed with cancer, and twice as many were dependent on prescription opioids than were injured in motor vehicle accidents in the previous year. 3,4 It has become progressively more evident that loose prescribing of prescription opioids feeds into a complex societal interaction that increases individual exposure to and risk of opioids, and may lead to increased use and abuse. Opioid dependence, which does develop into abuse and addiction, is a multifaceted illness that imposes signi ﬁ cant burdens on individuals, communities, and health care systems. Urgent and coordinated action is vital to address this widespread phenomenon. Health care providers must take ownership of their contribution to this issue and, moving forward, must adopt new strategies to correct the problems. Emergency physicians are by no means the only physicians contributing to overprescribing; however, as prescribers who often are unable to follow up on our patients, we recognize the need for decreased variability amongst emergency physicians ’ practices. To begin, Canadian emergency departments (EDs) should adopt opioid prescribing guidelines to standardize care and reduce harm. Although guidelines are not generally suf ﬁ cient to create change, they are an important ﬁ rst step in coordinating action. Currently, the Guideline Safe and Effective Use of for Chronic Non-Cancer Pain, the guideline created for Canadian physicians around opioid prescribing, is not speci ﬁ c for the needs of and guidelines could help standardize practices. Emergency physicians are also at the front line for treating overdose victims, putting us in a unique position to understand the magnitude of this issue. We must not be a part of the problem by contributing to the quantity of opioids circulating in communities, but instead be active parti-cipants in ﬁ nding solutions. Prescribing guidelines are only one part of a comprehensive solution. Harm reduction strategies are an important means to reduce morbidity and mortality and could be incorporated into prescribing guidelines, as in the BC Guidelines. CAEP and emergency physicians have a social responsibility to advocate for many of the key facets of a sustainable solution: more funding for addiction services, quicker access to primary care and community resources, physician accessible prescription drug monitoring programs, easier entry to chronic pain, and palliative services. Furthermore, mental health and concurrent disorders are often prevalent in this popu-lation and require comprehensive approaches that are not always available in physicians ’ day-to-day pain management. Prescribing guidelines could help promote the multidisciplinary treatment that is required to sustainably address the propensity for opioid-related morbidity and mortality. prescription opioids.