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

Kelowna skeet shooter wins two world titles

Bob LaRue also stands alone as only certified Level 3 skeet shooting instructor outside U.S.

Stolen vehicles found in Lake Country after collision on highway

All three vehicles were towed from the scene. The investigation remains ongoing at this time.

Wanted Prince George man found after break and enter in Kelowna

The 39-year-old Prince George man was taken into police custody without incident.

Do you own this dirt bike? Kelowna RCMP are searching for owners

The dirt bike was found abandoned last Monday

Peachland has largest number of mayoral candidates in the Central Okanagan

The mayoral candidates shared their reasons why they decided to run in the election

Rick Mercer says pot is ‘excruciatingly boring’

Comedian hopes Canadians will move onto something else once marijuana is legalized

Canada Post union issues strike notice; rotating strikes could begin Monday

Union says rotating strikes will begin if agreements aren’t reached with bargaining units

Carole James avoids questions on B.C.’s payroll tax (with video)

Green MLA Adam Olsen cites huge tax increase for local business

BCTF wins grievance over teacher shortage in public schools

Arbitrator found Chilliwack school district did not hire enough on-call teachers or librarians

2 charged for feeding B.C. bear Tim Horton’s timbits

Court documents show that Randy Scott and Megan Hiltz have both been charged with feeding or attempting to feed dangerous wildlife.

Killer-rapist Paul Bernardo set for parole bid after 25 years in prison

Bernardo’s parole hearing at the Bath Institution is expected to attract numerous observers

Feds aiming to select preferred design for $60B warships by end of month

Defence insiders say the government wants to select a design by the end of the month from among three options submitted by several of the largest defence and shipbuilding companies in the world.

B.C. city wants control over its cannabis advertising rules

Without a say, towns and cities risk Washington-State-style flood of advertising, proponent says

Defence cautions against mob justice in Calgary child neglect trial

Jennifer and Jeromie Clark of Calgary have pleaded not guilty to criminal negligence causing death

Most Read