ply when prescribing any drug, it also includes specific
expectations and guidelines for appropriate and effective
prescribing of narcotics and other controlled substances,
including opioids. The physician’s role is emphasized in
preventing and addressing the risk of abuse, diversion,
addiction, and overdose that may arise when opioids are
prescribed. Furthermore, the policy reflects the release
of the 2017 Canadian Guideline, and includes updated
guidance and recommendations on key issues, includ-
ing: considering alternative treatment options; selecting
appropriate doses; monitoring patients for signs of ad-
diction; and tapering. While the policy requires physi-
cians to be aware of and follow relevant clinical practice
guidelines when appropriate, it also emphasizes that
decisions with respect to prescribing opioids are always
a matter of individual professional judgment made in
consultation with patients who are fully informed of the
risks and benefits of opioid therapy.
Assessments
The College assesses physicians in their family medi-
cine and other specialty practices to ensure that they
are meeting the current standards of practice. Peer
assessments have always looked at prescribing practices
when applicable, and will include a new emphasis on
opioid prescribing. We are also exploring an alternative
approach to responding to potentially moderate-risk
prescribing by conducting focused assessments. Our
goal is to support continued prescribing when it is ap-
propriate and informed by both clinical guidelines and
College policy.
We also conduct regular assessments of physicians
who prescribe methadone for the treatment of opioid
dependence.
Investigations
The College will continue to work with the Ministry of
Health as necessary to identify levels of opioid prescrib-
ing and investigate prescribing practices that may be
harmful to patients. The College is aware that while
investigations may identify instances of risk of harm to
patients when opioid prescribing is continued, there
is also a very real risk of harm to patients when opioid
prescribing is discontinued. Understanding and ques-
tioning prescribing practices is not intended to discour-
28
DIALOGUE ISSUE 3, 2017
age appropriate opioid prescribing and it is imperative
physicians do not suddenly cease prescribing to patients
currently on opioid therapy.
Opioid-use disorder and chronic pain are health con-
ditions like any other, and treatments should include
all the elements of good practice: making recommen-
dations based on evidence and treating patients with
respect and compassion. For some, this may include
several tactics including a slow taper or opioid replace-
ment therapy/referral to a substitute treatment program
for methadone or suboxone.
Our goal is to support continued prescribing when it
is appropriate and informed by both clinical guidelines
and College policy.
Please see page 9 for an update on the status of opioid
investigations announced last November.
Facilitating Education
The College is collaborating with partners to help en-
sure that physicians receive the education, training and
resources they need to appropriately prescribe opioids.
Our role is to identify and connect physicians with
opioid prescribing learning needs to educational
resources to improve their prescribing practices. The
College supported the development of the University of
Toronto’s Safer Opioid Prescribing Program and contin-
ues to support updates to the program.
Partners’ Roles
More than 20 years in the making, Canada’s opioid cri-
sis has been propelled by corporate misrepresentation,
well-intentioned doctors, and patients with expectations
for quick relief. Inconsistent availability of chronic pain
centres, addiction services, and alternative therapies to
opioid pain relief within the health-care system has only
exacerbated the problem.
All system partners have a role to play and a respon-
sibility to work collaboratively to address a serious
public health crisis in Ontario. In addition to ensuring
that there are adequate treatment services for chronic
pain and addiction, the provincial government is also
well positioned to bring the key stakeholders together
to ensure that surveillance, education, assessment, and
investigations all occur as part of a coordinated prescrip-
tion monitoring program in which each player has a