Dialogue Volume 15, Issue 3 2019 - Page 8

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.