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

Multi-family housing zoning passed

The way is partly paved for 11 new multi-family strata buildings to go up in Smithers

Houston woman gets two years for aggravated assault

Ewald pleads guilty; trial of co-accused Calvin Dyrland begins in Smithers court

Two Smithers bowlers go to nationals

Madison Richter and Peyton Pettigrew are heading to Oshawa after winning gold at B.C. provincials.

New Work BC office scheduled to open April 1

Kopar Administration, the new Work BC contractor, still looking to fill positions in Smithers office

Gryphons girls graduate as coach moves on

Bulkley Valley SD54 van der Mark on his time as coach and education administrator.

Sparks fly as SUV speeds down wrong side of Highway 1 trying to flee RCMP

Captured on video, the vehicle headed westbound against oncoming traffic before crashing

Terror at sea: Helicopter rescues frightened cruise passengers in Norway

The Viking Sky cruise ship was carrying 1,300 passengers and crew when it experienced engine trouble

Search and rescue team helicopters injured climber from B.C. provincial park

A 30-year-old woman suffered a suspected lower-limb fracture in Skaha Bluffs Provincial Park

DOJ: Trump campaign did not co-ordinate with Russia in 2016

Attorney General William Barr said special counsel “does not exonerate” Trump of obstructing justice

Trudeau in Vancouver to support Tamara Taggart at Liberal nomination event

The former broadcaster is seeking the nomination for the Vancouver Kingsway riding

Trudeau calls May 6 byelection for B.C. riding of Nanaimo-Ladysmith

The riding opened up when Sheila Malcolmson resigned in January

B.C. VIEWS: The hijacking of our education system gathers speed

Children taught to strike and shout fringe far-left demands

Judges on Twitter? Ethical guidance for those on the bench under review

Canadian judges involvement in community life are among issues under review

Calgary captain has 3 points as Flames torch Canucks 3-1

Giordano leads way as Alberta side cracks 100-point plateau

Most Read