B.C. docs no longer restricted on opioid Rx
By Gillian Slade on June 9, 2018.
gslade@medicinehatnews.com @MHNGillianSlade There has been a change in requirements for B.C. doctors treating chronic pain patients and prescribing opioids. In future they will be required to prescribe opioids without limiting the dosage, according to a Canadian Press story this week. The announcement was unexpected in Alberta. “I was extremely surprised. It is out of character,” said Barry Ulmer, executive director, The Chronic Pain Association of Canada. The standard was set in B.C. in April 2016 following the increase in overdose deaths generally linked to illicit fentanyl. A link was made to illicit drugs and people who had previously been on prescription opioids. B.C. physicians became the first in Canada to face mandatory regulations involving prescription opioids. The B.C. College of Physicians and Surgeons required doctors to limit dosages of drugs like hydromorphine, oxycodone and the fentanyl patch to the equivalent of 90 milligrams of morphine per day. Those doctors are now required to work with the patient to determine what an appropriate dosage would be. They also cannot exclude or dismiss a patient because they are taking prescription opioids. In the story, by Camille Bains for The Canadian Press published June 6, the B.C. college registrar Heidi Oetter is quoted as saying dismissing patients because they are on opioids is a “violation of the human rights code” and that it’s “not acceptable or ethical”. The Alberta College of Physicians and Surgeons has always made it clear a doctor should not dismiss a patient for these reasons. On its website it asks patients who have experienced this to file a complaint. Ulmer says it is much more subtle in Alberta. Doctors do not refuse to take a patient on and tell them it is because they are on opioids. “I hope it changes because it is creating havoc in the pain community,” said Ulmer. When the guidelines for prescribing opioids first emerged a few years ago in the U.S., Alberta was one of the first provinces to follow B.C.’s example with certain recommendations to follow the guidelines. Ulmer has doubts about whether this B.C. ruling will influence the position Alberta has taken. “The Alberta group that are pushing for the restrictions are pretty entrenched,” said Ulmer. “I hope the B.C. change will have some effect.” 16
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