Dear Editor
LETTERS TO EDITOR
Dear Editor
Re : College Releases Outcomes of Opioid Investigations ( Dialogue , Volume 13 , Issue 3 )
The issue that is rarely discussed in the midst of this opioid crisis is that most patients do not have access to assessment and treatment of the factors that cause or contribute to their pain – the services of physiotherapists , massage therapists , nurses , occupational therapists , psychologists and social workers . These services are not covered , or are minimally paid for by publicly funded outpatient health-care systems in Canada . Evidence shows that multidisciplinary care , which includes the interventions of these professionals , can assist patients with chronic pain . A holistic approach incorporating prevention , active treatment , rehabilitation , and community care is strongly advocated as mainstream treatment , but this approach is rarely available for physicians as they try to manage their patients ’ pain in their offices . Opioid overprescribing can oft be considered to be a surrogate for inadequate societal pain management resources . People are suffering in pain and they deserve scientifically directed treatment . Unfortunately , current medical outpatient models minimally support services such as physiotherapy , social work , psychology , exercise therapy and others , which are the cornerstone of pain care . In an issue of Canadian Family Physician ( Vol 62 : June 2016 “ Opioid Prescribing is a Surrogate for Inadequate Pain Management Resources ”), I and my fellow authors – David N . Juurlink MD PhD FRCPC ; Barry Power PharmD ; Tara Gomes MHSc ; Nicholas Pimlott PhD MD CCFP – have detailed why this model needs to change . Physicians and bodies such as the CPSO must recognize the above and make clear that unless the needed pain services are provided to family doctors , the issue cannot be resolved .
Sincerely , Hillel M . Finestone , MD Ottawa , Ontario
Re : College Releases Outcomes of Opioid Investigations ( Dialogue , Volume 13 , Issue 3 )
Some years ago , when I was an elected representative for Toronto doctors to the OMA , I recall the rollout of the Narcotic Monitoring System . Other than the inability of physicians to access the information , there was widespread support . Questions were asked about the eventual use of the data to identify unusual prescribing patterns and my recollection was that the likely initial action would be in the form of educational detailing . Instead , the governmental decision was to report the names of physicians to the CPSO based on statistics without reference to individual practice patterns . There is an undeniable fear of referral to the CPSO but the wave of fear spreads far beyond those targeted to all physicians who are struggling to provide appropriate care to those patients who benefit from opioids . I view the government action as a betrayal of the principle of appropriate consultation with both regulatory and organizational medical representatives . It has likely placed many patients at risk of sudden withdrawal . I am largely retired from office practice , but still have a few of these patients whom I am unable to transfer to fellow members of a spooked profession . These patients ' safety now depends on my personal health or licence status because of the resultant climate of fear of investigation .
Sincerely , Stanley Lofsky , MD Toronto , Ontario
The College Responds : The College thanks Dr . Lofsky for his letter . We would respectfully suggest that understanding and questioning prescribing practices is not intended to discourage appropriate opioid prescribing . Where an investigation is warranted , the College will seek more information from the prescribing physician in order to better understand and evaluate the prescribing . Of the investigations launched in 2016 , the vast majority resulted in an educational outcome . These actions underscore the College ’ s belief that prescribing opioids under
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DIALOGUE ISSUE 4 , 2017