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

Bandits steal Vernon Jazz Club stage

Milk Crate Bandits perform Oct. 20

CFNO site queries Vernon council, mayor candidates

Community Foundation of the North Okanagan has launched vitalvernon.org

2019 IPE tickets on sale now

The theme for next year’s annual exhibition and stampede in Armstrong is ”Horsin’ Around”.

Okanagan College looks to reduce natural gas consumption

The college’s natural gas consumption has dropped 51.7 per cent in a decade

The 50th annual Vernon Ski Swap

According to representatives, hundreds lined up starting at 7 a.m. to get a first look at the equipment.

Documentary series investigates missing North Okanagan women

APTN Investigates: Dark Valley airs Oct. 19

Enbridge to begin building road to access pipeline explosion site in B.C.

An explosion Tuesday knocked out a 91-centimetre line

Andrew Scheer on revamped NAFTA deal: ‘I would have signed a better one’

Conservative leader says he wouldn’t have signed USMCA

Matheson will have NHL hearing after Canucks rookie Pettersson hit

The 19-year-old Swedish centre appeared woozy after the hit

GUEST COLUMN: A better way to manage B.C.’s public construction

Claire Trevena responds to Andrew Wilkinson on NDP union policy

B.C. brewery creates bread beer from food waste

The brew aims to raise food waste awareness and provide funds for the food bank

Dad files Charter challenge after B.C. bans kids from taking transit unsupervised

Adrian Crook is taking his fight to B.C. Supreme Court

B.C. VIEWS: Cast your municipal vote for sanity on homelessness

Thousands on waiting list while anti-capitalist bullies get priority

Most Read