The opioid crisis has taken
a disproportionate toll on
First Nation Canadians. In
an upcoming issue we will
look at why so many com-
munity leaders have de-
clared a state of emergency
in their communities.
DIALOGUE ISSUE 1, 2019
When responding to requests for narcotics and controlled substances,
physicians can implement a number of practical steps to help prevent
diversion 1 :
Verify the presenting complaint through an assessment.
Observe for aberrant drug-related behaviour.
creen for current and past alcohol, drugs (prescription and non-pre-
scription) and illicit drug use.
o Consider using screening tools from the Canadian Guideline for Safe
and Effective Use of Opioids for Chronic Non-Cancer Pain.
for signs that a patient who legitimately needs opioids may be
selling part of their prescription to supplement their income (i.e. asking
for a large number of pills).
I f the patient is not well known to you, ensure the patient’s identity has
sk the patient if they have received any narcotics or controlled sub-
stances in the last 30 days from another practitioner. Under the federal
Controlled Drugs and Substances Act, it is an offence for a patient to
fail to disclose this information to a physician.
I f available, access the patient’s prescription history. One of the digital
health reforms now being implemented in Ontario allows physicians
to access the prescription history of patients in real time. Physicians
can access the patient’s prescription history of publicly funded drugs,
monitored drugs, and publicly funded pharmacy services. Currently, this
access to prescription history appears to be more widely available to
hospital physicians than to community physicians.
imit the number of pills dispensed
wherever possible and clinically appro-
priate to do so.
We advise physicians consider and apply (as appropriate) the
Canadian Guideline for Safe and Effective Use of Opioids for
Chronic Non-Cancer Pain in their decision-making.
Drug Diversion Program recognizes
that physicians may be uncertain
about how to proceed when they
suspect they have been an unwit-
ting pawn in a diversion scheme.
He recommends that physicians
give him a call for advice at (519)
494-1043 or send him an email at
[email protected]. “If a physi-
cian suspects fraud, then I am
happy to talk to him or her about
what options are available. I will
often point out that while they may
think they are the only physician
being targeted, in fact, the fraudster
likely has a whole network of physi-
cians that he or she is defrauding in
In this article, we describe the
precautions you can take to minimize
the risk of drug diversion and your
obligations should you become aware
of illegal activities affecting your prac-
tice. We encourage you to read our
Prescribing Drugs policy for further