B.C. doctors first in Canada to face mandatory prescribing standards for opioids and other addictive drugs
B.C. doctors have become the first in Canada to be legally bound by College of Physicians and Surgeons standards on prescribing opioids and other addictive drugs.
B.C. doctors have become the first in
Canada to be legally bound by strict new standards for prescribing
opioids and other addictive drugs.
The mandatory prescribing program of
the College of Physicians and Surgeons of B.C., which took effect
Wednesday, comes about because of an epidemic of narcotic addictions and
deaths. Doctors who don’t follow the mandatory, professional standards could face complaint hearings and disciplinary actions like fines and licence suspensions.
The standards replace guidelines
that were only recommendations on proper and safe prescribing of pain
medications, sedatives, stimulants and other addictive medications. The
guidelines allowed for some discretion; the new standards do not.
“It’s not a matter of if, when or maybe,”
said Dr. Ailve McNestry, deputy registrar of the College, referring to
the new standards.
“Unsafe
prescribing needs to stop,” said Dr. Gerry Vaughan, president of the
College’s board. “The new document clearly states what our registrants
must and must not do when prescribing certain classes of drugs,
especially if there is a risk of misuse or diversion.”
Last year, up to 200 doctors were ordered by the College to take educational programs to learn how to properly prescribe opioids and other addictive drugs.
Under the standards, doctors must now have discussions
with patients about alternatives to opioids, especially for conditions
like low back pain, headaches and other ailments that don’t require
such medications. Doctors must take careful patient histories and do a
risk-benefit analysis to consider if opioid therapy is safe.
McNestry said some mental health patients may be
vulnerable to addiction, as are patients who have abused alcohol or come
from families where addiction is a problem. Doctors must
review PharmaNet records to see if a patient has taken such medications,
because some individuals doctor-shop in order to collect more pills to
either use themselves, give to others or sell on the street. If
doctors do end up prescribing such medications, they are now required to
start with the lowest dose, for a short time period, and monitor
patients frequently.
While some opioids like fentanyl are illegally imported into B.C. or
manufactured here by organized crime networks, the College says doctors
have also had a role through inappropriate prescribing of opioids and
other medications.Dr. Perry Kendall, the provincial health officer, said a few months ago that B.C. has “a public health emergency” and as many as 800 people may die from opioids in 2016, almost double the number in 2015.
McNestry said B.C. is unique in introducing standards. Provinces have historically taken only an educational approach to prescribing recommendations.
“We are now calling these legally enforceable standards. Our mandate is public protection and if education doesn’t (achieve) that, then we need to do something more,” she said. While chronic pain doctors and their patients may have “valid”concerns about how the changes will affect them, McNestry said the College must do more to stop the overuse of such medications.
“There’s just too many people suffering from the side effects of high dose opioid therapy. There are people who are being prescribed dangerous combinations of drugs (opioids and sedatives), leading to people stopping to breathe.”
According to IMS Brogan, which monitors pharmaceutical sales, Canadian doctors have been heavy prescribers of opioids, writing 53 prescriptions for every 100 people. McNestry said one doctor who came to the attention of the College recently had prescribed 80,000 opioid tablets in a three-month period.
The new standards are based on a set published in March by the U.S. Centers for Disease Control and Prevention. The B.C. College and its board adopted them because they didn’t want to wait any longer for proposed new Canadian standards. The current national guidelines are six years old.
McNestry said coroner’s reports, which are
reviewed by College officials, showed that a disturbing number of
people who died of overdoses were never prescribed the medication that
killed them, which means they had obtained drugs illegally. A Vancouver Sun series earlier
this year showed that some health professionals steal opioids from
hospitals for their personal use or sell them on the streets.
Health Issues Reporter
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