To be used in conjunction with physical and distraction interventions.
Reassess response to pharmacotherapy regularly. Re-dosing, as required, is recommended.
Diagnostic accuracy is NOT affected by the provision of early analgesia.
Intramuscular and subcutaneous injections should be avoided in children, as intranasal and intravenous options provide less painful modes of delivery and more predictable absorption.
For infants <12 months old, consultation with Pediatric Referral Centre is advised for recommendations when opioids or IV analgesics are being considered for pain management.

Titrate all opioids to clinical effect and to minimize adverse effects.
Always use opioids as co-therapy and never on their own.
Side effects such as nausea, sedation, or confusion can be mislabeled as an allergy. An accurate drug allergy history is essential as true allergy to morphine and other opioids is extremely rare; cross reactivity is also rare.
Health Canada and the US FDA advise avoidance of codeine in children <18³ and hydrocodone in children <6.⁴
Opioid administration prior to procedural sedation increases the risk of oxygen desaturation, vomiting, and need for positive pressure ventilation. This risk is greatest if procedure is performed within 30 min of opioid administration.
All families should have a substance use risk assessment performed before prescribing outpatient opioids.
If discharging patient home with PO opioids, prescribe for no more than 3 days (or 10 doses total) for most conditions.
Recommend stool softener for those discharged with PO opioids. Refer to TREKK Recommendations for Constipation.
Opioids should be stored safely out of reach and only given as needed. Unused quantities of any medication should be returned to the pharmacy or disposal site for safe disposal.