Opioids : Addressing Inappropriate Prescribing
PROTECTING
Opioids : Addressing Inappropriate Prescribing
Given the very real evidence that we are in the midst of an opioid crisis , the College began intensifying efforts in 2016 to address the issue of inappropriate and potentially unsafe prescribing .
In 2016 , we investigated a significant number of physicians whose prescribing practices had been flagged by the Narcotics Monitoring System ( NMS ) as potentially concerning . The NMS was developed by the Ministry of Health and Long- Term Care to identify drug utilization patterns and trends and to detect unusual prescribing activities .
The Ministry is able to provide information to the College where it appears , based on NMS ’ analysis of dispensing data , that physicians are engaging in practice patterns that may not be consistent with the Canadian Guideline and may suggest a possible risk to patients , either by prescribing high doses or prescribing opioids in combination with benzodiazepines .
Upon receipt of this information , the College considers the accuracy of the data , and the clinical context in which prescribing occurs , and then seeks information from the prescribing physician in order to better understand and evaluate the prescribing .
Our concern , from the start , was the potential for these investigations to cause patient terminations either as a result of the investigations or as part of a general ‘ chill ’ effect . We regularly communicated to physicians that sudden withdrawal could cause serious patient harm and , therefore , the abrupt cessation of prescribing to a patient is never acceptable .
If the College ’ s investigation finds that a physician chooses not to take advantage of the tools and resources available to him or her , then we will take additional action . We take the issue of unsafe prescribing very seriously and if there is concern that a physician is not practising at the expected standard of practice , sanctions can range from restricting the physician ’ s practice , requiring the completion of remediation or to the most serious outcome of revocation .
But we understand that investigation is just one tool that can be used to address inappropriate prescribing . In 2017 , we launched an Opioid Strategy that puts patient and public safety at the forefront . Within the Strategy , the College has identified and committed to specific actions to ensure safe and appropriate prescribing . These actions include investigation , assessment , guidance and education .
Our work in this area will be informed by the new Canadian Guideline , as well as by our continued work with a broad range of partners . Long-term success at addressing this crisis will continue to require the coordinated action of many and we are dedicated to using all our resources to help bring an end to the crisis .
PHOTO : iSTOCKPHOTO . COM
20 COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO