B.C. doctors told not to limit opioids or refuse care of chronic pain patients

College of Physicians and Surgeons of B.C. updated its standard of practice for prescribing opioids

The college that oversees doctors across the B.C. has updated its guidelines for prescription opioids, now requiring doctors to prescribe certain drugs and sedatives to those suffering from chronic pain without limiting dosage or refusing to see the patient.

The revisions by the College of Physicians and Surgeons of B.C. will be sent to doctors this week, said college registrar Dr. Heidi Oetter, following months of draft revisions and consultations with both doctors and the public.

The original college guidelines came to fruition in 2016, before any national guidelines existed in Canada, as B.C. saw a drastic uptick in illicit drug overdoses. Officials turned to over-prescribing at doctors clinics as one facet of the overdose spikes. Since then, the province has led the way in some of the highest death tolls due to the powerful illicit drug fentanyl.

READ MORE: 391 people died of illicit drug overdose in B.C. from January to March

READ MORE: Naloxone prevented 26% of possible overdose deaths in B.C.

READ MORE: More than 1,400 people in B.C. died of drug overdoses in 2017

But as the guidelines looked to tide what has become an epidemic in the province, those suffering from chronic pain were concerned their level of care would be impacted.

Complaints received by the college were mixed, with some people who felt they weren’t getting the prescription they needed and others who alleged cases of over-prescribing, Oetter said. The college is hoping the updated standard of care clears up misconceptions doctors may have.

Now, when physicians are prescribing doses of opioids higher than 90 mg of morphine equivalent, they have to document evidence of the need, Oetter said, but cannot refuse care.

“We really wanted to make it front and centre that it was unacceptable for physicians to refuse to see – or fire – patients, or exclude from taking on patients who were either on opioids or had a history of using opioids, because that simply is discrimination and that is not acceptable,” Oetter said.

The prescription practices do not apply to cancer patients, or those in end-of-life care, Oetter said, nor those who are seeking treatment for substance use disorder. “Some physicians were thinking it applied to them and it clearly doesn’t,” she said.

Opioid prescribing for patients of acute-pain, such as after surgeries or accidents, is also not included in the updated standard of care. Oetter said the college is looking forward to findings compiled by the DeGroote School of Medicine at McMaster University on safety and public policy measures that can be taken in the future.

College reinforces tapering of opioid prescriptions on trial basis

Doctors having to document and record why they are prescribing opioids is included in the new standard so doctors can both confidently prescribe powerful pain medications, but also reasses whether the patient is truly benefiting from high doses over time.

Oetter said doctors can look to modern studies that show physiotherapy, weight management and other non-drug related options have proven to be positive for patients.

“The emerging evidence says that patients don’t necessarily do better when they are on more [drugs],” Oetter said.

For many decades, physicians were told long-term opioid therapy was safe and that there was no need to consider limiting dosage, Oetter said, but new evidence is reigning that in and recommending doctors instead work with patients to taper opioid prescriptions while recognizing is often trial attempts and continuous follow up.

“The tides are turning a bit,” she said. “Patient-centred care really needs to balance the risks with the potential benefits and all other treatment options really need to be considered for the patient.”

College of Physicians and Surgeons of British Columbia: Safe Prescribing of Opioids by Ashley Wadhwani on Scribd


@ashwadhwani
ashley.wadhwani@bpdigital.ca

Like us on Facebook and follow us on Twitter.

Just Posted

Saanich entrepreneurs face off against the Dragons on television

CBC segment featuring Endur Apparel business partners airs Jan. 24

Langford Fire Rescue partners with Wounded Warriors to focus on mental health

B.C. organization addresses mental health of veterans, first responders and their families

Amalgamation advocate predicts citizens assembly in place by late spring

Shellie Gudgson promises Amalgamation Yes won’t participate in assembly

‘It’s just hair:’ Central Saanich woman chops her locks for Wigs for Kids

Wigs for Kids BC will receive two 12-inch braids from Brentwood Bay resident Liza Glynn

New orca calf in Salish Sea ‘healthy and active’

Birth cause for celebration but things still dire genetically, expert says

POLL: Should people have to license their cats?

The Victoria Natural History Society has sent letters to 13 municipalities in… Continue reading

Razor burn: Gillette ad stirs online uproar

A Gillette ad for men invoking the .MeToo movement is sparking intense online backlash

Feds poised to bolster RCMP accountability with external watchdog

Long-anticipated move is the latest attempt at rebuilding the force following years of sagging morale

Canada needs a digital ID system, bankers association says

The Department of Finance last week officially launched its public consultation on the merits of open banking

Second fatal crash occurs in Alberni Valley

Traffic on Highway 4 is being re-routed as investigators are en route

Indigenous energy summit includes session on pipeline ownership options

Steven Saddleback of the Indian Resource Council says a session will feature presentations on financing models

Japanese grand champion Kisenosato retires from sumo

The 32-year-old Kisenosato was the first Japanese-born wrestler in 19 years to gain promotion to sumo’s highest rank

UPDATE: Accused B.C. high school killer found fit to stand trial

Gabriel Klein is accused in the 2016 stabbing death of Letisha Reimer at Abbotsford Senior Secondary

Most Read