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

Victoria invited to get a closer look at Sunday’s lunar eclipse

Special event allows public to view the moon through UVic telescopes

Overworked and understaffed: More than 300 vacancies in Vancouver Island nursing

Tentative deal with province includes ‘working short premium’ to encourage hiring

Victoria Whisky Festival kicks off this weekend

Whisky-lovers flock to Hotel Grand Pacific for weekend events and tastings

Victoria city council seeks authority to tax empty homes

Council is asking the province for the authority to invoke a vacancy tax

25 drivers in Victoria pulled for drug impairment since cannabis legalized

Little change seen in number of impaired drivers since new laws enacted

Fashion Fridays: Inspirational gym outfits

Kim XO, helps to keep you looking good on Fashion Fridays on the Black Press Media Network

Condo rental bans may be on way out with B.C. empty home tax

Many exemptions to tax, but annual declarations required

Greater Victoria Crime Stoppers wanted list for the week of Jan. 15

Greater Victoria Crime Stoppers is seeking the public’s help in locating the… Continue reading

POLL: Should people have to license their cats?

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

Missing B.C. boy and aunt found safe

The pair had been reported missing from Kamloops

Company issues lifetime ban after man jumps from cruise ship

Nick Naydev posted the video last week showing him standing on the balcony of the Symphony of the Seas

Inflation rises as higher airfares, veggie prices offset cheaper gas

Statistics Canada says inflation accelerated to two per cent in December

Social media strains over Prince Rupert’s boil water notice

Resident forms Community for Clean Water, and Jennifer Rice responds to acting mayor’s comments

Dog dies saving B.C. family from burning home

Homeowners safe but one pet missing, another confirmed dead following fire

Most Read