According to the College of Physicians and Surgeons of Alberta (CPSA), the province’s opioid prescription rates are among the highest in the country.
Now, the regulatory body is taking action with a set of proposed new guidelines for the safe prescription of fentanyl and other opioids.
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The new rules would mean more steps for doctors when they are assessing a patient’s risk of addiction, including possible drug screening and prescribing limitations.
“Physicians have been, over time, too liberal for a number of reasons, good reasons in large part – and it’s time we do something to correct that,” Dr. Trevor Theman, the CPSA’s registrar, said.
The college wants the current daily maximum dose dropped to less than half of what it currently is, unless a doctor can justify otherwise.
“Even patients who are on starting doses of most oral opioids – or transdermal opioids such as fentanyl – are already pretty close to the watchful dose, so there’s not a lot of room,” Dr. Brian Knight, an Edmonton-based anesthesiologist, said.
Knight also said the new rules would add extra work for already busy family doctors and could possibly discourage them from taking on chronic pain patients.
The current practice of prescribing requires triplicate prescriptions for anything stronger than codeine. That means the prescription has three copies. One is sent to the pharmacy, one is kept at the doctor’s office and the third is sent to the college and entered into a database. There is no requirement for doctors to check a patient’s history.
“Our members should be prescribing the lowest dose possible,” Theman said. “If they have patients on really high doses, they should be working to reduce those doses and be looking at other kinds of treatment.”
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Patients themselves are speaking out about the possibility of losing access to opioids.
“It’s got such a bad name right now,” Sam Galm said of the pain medication fentanyl.
Galm recently weaned herself off a fentanyl patch voluntarily because she was afraid new prescribing rules would block her access to it.
She is using it to treat her chronic pain.
“I’m in agony. It’s a never-ending pain.”
Galm has tried chiropractic, physiotherapy and massage therapy to cope. Opioids were her last resort but since quitting fentanyl, she can barely leave the house.
But according to the Edmonton Police Service, prescription drugs are a problem.
“From 2012 forward, the amount of files that I see that involve prescription abuse have increased considerably and … (people) are travelling around or being stopped with literally Ziploc baggies full of assorted pills, selling them on the street,” Det. Guy Pilon said.
Pilon said many of those drugs are acquired through the health care system whether it’s through a prescription, acquired from someone who doesn’t need the pills anymore or through theft.
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But Knight acknowledges most patients on large doses of opioids are highly functional and responsible. He worries about how it might affect the doctor-patient relationship.
“Any time you’re asking a patient to pee into a bottle, it becomes a punitive aspect to it,” he said. “It’s going to result in a lot of little old ladies for example, with compression fractures, getting urine drug screens. But occasionally, you do catch somebody that you didn’t think was using it.”
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The CPSA says patients will not be abandoned.
“Those patients need to be treated, not abandoned. They need to be treated as responsibly and carefully as possible. For some, that might mean weaning them off. For others, that might mean addiction treatment,” Theman said.
Members of the public, along with health professionals, are being invited to give feedback about the new guidelines on the CPSA website until Dec. 12.
For Galm, the decision to stop using opioids was the right thing to do but for others it will not be that easy. Galm recalls a friend who was forced to reduce his medication and, in the end, took his own life.
“I’m worried that there’s going be more people that take that route, because when you can’t do anything because of pain – what’s the point?”
With files from Su-Ling Goh