November 14th, 2019

Doctors ‘terrified’ to prescribe opioids after being tracked

By Gillian Slade on January 7, 2017. 

Physicians prescribing opioids are being monitored by the College of Physicians & Surgeons Alberta (CPSA) with regular tracking reports issued.

It has “terrified” doctors and chronic pain patients alike, says the Chronic Pain Association of Canada.

This is one way to address the increased use of prescription opioids, particularly for people with chronic pain, said CPSAregistrar Dr. Trevor Theman.

A local physician, who spoke on condition of anonymity, told the News this process has “terrified” some doctors who have decided to no longer prescribe opioids — period.

While physicians cannot refuse to treat a chronic pain patient, simply telling them they will not prescribe opioids is a way of refusing to take them on as patients, a doctor said.

“They (chronic pain patients) are terrified the same as the physicians — as soon as they (doctors) get that letter outlining their patients and how much they’re taking with comparisons to their peers,” said Barry Ulmer, Chronic Pain Association of Canada executive director.

Theman says this is unfortunate.

“That is not the intention. It is something of an over-reaction to the messaging that we’re sending,” said Theman.

Prescribing opioids using the lowest effective dose is important, he explained, and there are detailed CPSA guidelines for physicians.

“Nobody will be in trouble for rational use of them,” said Theman.

There is a concern of increased suicide rates when people with chronic pain have no where to turn for relief. There is also the risk of them turning to the illicit opioid market with potentially deadly consequences.

“That is a risk,” said Theman.

Chronic pain is the largest chronic disease problem with 20 per cent of the population afflicted, said Dr. Gaylord Wardell, anesthesiologist and pain specialist in Medicine Hat.

“Addiction is a much less prevalent disease but receives far more interest,” said Wardell. “Thereis no opioid crisis in Canada, but there is a problem with illegal use.”

Theman says there are two opioid issues — those obtained illicitly and those prescribed by a physician. In a recent interview with Dr. Nick Mitchell, senior medical director, addictions and mental health strategic clinical network with AHS, he said the majority of people in emergency departments with an opioid overdose are young males without a history of prescription opioid use.

Theman says the CPSA is addressing prescription opioid use as opposed to illicit opioid use.

A recent study in North Carolina on prescription overdoses showed that of 2,182,374 patients prescribed opioids, there were 478 deaths reported — 0.022 per cent per year.

The News suggested to Theman that this did not sound very high.

“Yes I get it,” said Theman, who pointed to data available at the Canadian Medical Protective Association (the organization that insures Canadian doctors) in Vancouver in August 2016.

In a presentation, Dr. Gary Franklin, medical director of the Washington State Department of Labour and Industries, showed “risk” related to dosage of opioids. The risk increased at the dosage increased, said Theman.

The Canadian Medical Association Journal talks about “a growing crisis” with the number of opioid-related deaths having a five-fold increase.

A study of veterans in the U.S. 2004-2008 showed the risk of death following an overdose was directly related to the maximum prescribed daily opioid dose — 100 mg.

“There is evidence that shows that the higher the dose, the greater the risk,” said Theman.

CPSA does not collect data to show whether the prescriptions for opioids are for chronic or acute pain.

“I would make an assumption that in almost all these cases we’re talking about chronic pain,” said Theman. “Because nobody’s going to walk out of the hospital or emergency department or a doctor’s office with a first-time prescription of 200 oral morphine equivalents a day.”

Theman says the CPSA has not been hearing much from chronic pain patients but decided to put an advertisement in the News just before Christmas telling chronic pain patients that CPSA cared and they were not being abandoned.

“The piece of the opioid crisis that we can address as a college is prescribing by our members,” said Theman. “We have no way to impact the illegal fentanyl crisis.”

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