The College of Physicians
and Surgeons of Ontario
and the Ontario College
of Pharmacists developed
a fact sheet about the
requirements under the
new legislation. Please
read at www.cpso.on.ca.
another provider, or a concurrent
fentanyl prescription from another
provider.
The prescribing physician is expected to be “reasonably satisfied”
that the patient has not already
received/is not already receiving
fentanyl from another prescriber,
based on their discussion with the
patient and any other information
available to them.
Physicians who prescribe fentanyl patches must
explain to patients what is required of them under
the regulations. This explanation must stress the
importance of patients keeping track of every patch,
whether used or unused, until it is returned to the
pharmacy, because patients who misplace patches
will have difficulty obtaining new ones, and because
unattended or carelessly stored patches are frequently
lost or stolen.
Physicians are also expected to make themselves
available in a timely and professional manner to
pharmacists who call to confirm the validity or other
details related to a prescription, or to raise questions
or concerns regarding the number of patches returned by a patient (among other potential issues).
As is already required by the College’s Prescribing
Drugs policy, patient choice must be respected in
selecting the pharmacy that is named on each prescription (specifying the pharmacy that will fill the
prescription is required under the Act).
Earlier, during the consultation on the proposed
regulation, the College expressed support for the introduction of a patch-for-patch fentanyl program. In
the submission, however, the College was clear that
any individual effort to reduce the abuse, misuse, or
diversion of a specific drug must be part of a coordinated, system-wide strategy in order to ensure a
lasting effect.
For this reason, the College believes that the Min-
14
Dialogue Issue 3, 2016
istry of Health and Long-Term
Care should evaluate the outcome
of the implementation of this legislation. “History has shown that
with any drug control mechanism that focuses on a specific
drug, limiting access often results
in increased demand for other
prescription or illicit drugs. The
Ministry should establish baseline
data and monitor this anticipated consequence of the
proposed regulation,” wrote Dr. Rocco Gerace, College Registrar, in the College submission.
The College also stated that the Ministry should
ensure that physicians who prescribe opioids have
more complete and timely access to information
about a patient’s opioid medication history prior to
prescribing, such as through the provincial Narcotics
Monitoring System (NMS). There may also be value
in considering new or revised NMS alerts, particularly in order to better inform physicians when a new
patient has previously received a fentanyl prescription from another prescriber, wrote Dr. Gerace.
Originally developed as an operating room drug,
fentanyl is approximately 100 times more potent
than morphine and 40 times more potent than heroin. It has been described by The Canadian Guideline
for Safe and Effective Use of Opioids as a second line
drug for severe pain, and should only be considered
if morphine, oxycodone or hydromorphone are not
appropriate for the patient.
Physicians who prescribe fentanyl patches are
advised to review guidelines. The Canadian Guideline for Safe and Effective Use of Opioids is available
at http://nationalpaincentre.mcmaster.ca/opioid
and the Centers for Disease Control guideline is at
https://www.cdc.gov/. Physicians must also ensure
that they comply with the requirements of the College’s Prescribing Drugs policy when prescribing
fentanyl.
MD