LETTER TO THE EDITOR
TO THE EDITOR:
Re Opioid Prescribing (Dialogue, Issue 2, 2019)
In a feature article of Dialogue, Dr. Steven Bodley at-
tempts to reassure physicians that when they prescribe
opioids, they should be "entirely confident that they
will be supported by the College if they make...deci-
sions... that have the patient's best interest at heart."
But his words ring hollow. In October, 2016, 84
doctors were named in a CPSO-led investigation into
their competence to practice (Section 75) based solely
on data received from the 2015 Narcotics Monitoring
System. This precipitous action has generated an enor-
mous amount of anxiety among those doctors who are
still prescribing opioids, although they are trying hard
to keep their patients' interest at heart. It will take more
than reassuring platitudes to eradicate that fear
Those 84 doctors were all immediately assumed to
be dangerous opioid prescribers and faced loss of their
medical licence. Protracted time-consuming investiga-
tions ensued over the next 18 months. In May, 2018,
the final results were published. In 29 cases, the recom-
mendation was no action, or advice only. A serious out-
come, which would have justified invoking the Section
75 act was found in five doctors, two referred to the
Discipline Committee and three placed on prescribing
restrictions. But the collateral damage was high and will
continue to play out for years. A useful outcome was
that 46/84 received mandated remediation. Will there
ever be an investigation into the practice of doctors
who refuse to prescribe any opioids, no matter what the
clinical scenario? We all know the answer.
To demonstrate to Ontario physicians that "their
College is behind them," I suggest that the CPSO
consider the following recommendation. A doctor who
has chronic pain patients on an opioid dose exceeding
the currently recommended 90 MEDs/day should be
able to inform the CPSO proactively and without fear
of retribution of the measures he/she has undertaken
The College edits letters for length, and clarity.
8
DIALOGUE ISSUE 3, 2019
to prescribe opioid alternatives, to taper, to seek second
opinions and consultations. They should be able to
receive advice in a timely fashion regarding the neces-
sary resources in their region. This indicates both an
awareness of the guidelines and thoughtful judgment in
patient management.
Dr. Bodley expressed optimism about the recently-
established Canadian Pain Task Force which will advise
Health Canada on best practices for prevention and
management of CP. In my opinion, a federal Task Force
is a step in the right direction, but will do little to help
physicians and RNs on the front line facing marginal-
ized patients.
Sincerely,
Pat Morley-Forster MD, FRCPC
Anesthesiology and Pain Medicine, Founder Status
THE COLLEGE RESPONDS:
We thank Dr. Morley-Forster for her letter.
We acknowledge, in retrospect, that the steps we took
to address opiate prescribing concerns had unintended
consequences that were not fully realized or appreciated.
In fact, we found that the majority of physicians were
practising appropriately and that high-dose opioid pre-
scribing has a place in the care of some select patients.
We’re continuing to improve our Opioid Strategy
to address this evolving crisis while reassuring physi-
cians that appropriate prescribing can take a number of
forms. It is our hope that physicians will be reassured
that if they demonstrate good clinical judgment and
treat patients appropriately for their individual circum-
stances, that the College’s expectations will be met.
The College recognizes that appropriate opioid
prescribing is complex and that physicians are working
diligently to provide patients with the best possible care.