Alberta college seeks feedback from doctors on draft opioid prescribing rules

Alberta's medical regulator wants more stringent rules on how physicians prescribe opioid painkillers and other drugs to improve the safety of patients.

The College of Physicians and Surgeons says next month it will send draft proposals for a standard of practice called "Safe Prescribing" to doctors, the provincial government and others seeking feedback in the hope of approving it next March.

The college notes that opioid prescribing by Alberta doctors is among the highest in the country, and that Canada is one of the top three countries in the world for painkiller use.

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"Data obtained from the Triplicate Prescription Program in 2015 reveals a significant number of Alberta physicians continue to prescribe opioid dosages in excess of the maximum recommended dose in the 2010 Canadian guideline for safe and effective use of opioids for chronic non-cancer pain," says a memo about the proposed draft standard of practice.

Some prescription opioids include codeine, morphine, oxycodone and fentanyl patches.

Alternate treatment programs needed, doctor says

The proposed standards would require doctors to prescribe the lowest effective dose to patients who require long-term opioid treatment for chronic pain other than cancer.

Physicians would have to discuss medication decisions with patients including potential serious side effects, other treatment options and the probability of the drug improving their health.

Alberta and Canada have a huge issue aroundopioidoveruse and misuse.Others have called it a crisis, and I think that is a fair characterization.- Dr. TrevorTheman, registrar of Alberta's college

Doctors would also be required to regularly track a patient's drug treatment history through Alberta's pharmaceutical information network.

Dr. Trevor Theman, registrar of Alberta's college, said they want to move quickly with changes after they hear back from physicians and the government.

"Obviously Alberta and Canada have a huge issue around opioid overuse and misuse," he said. "Others have called it a crisis, and I think that is a fair characterization."

Last March, the U.S. Centers for Disease Control (CDC) released new guidelines to improve the way opioids are prescribed to help reduce the number of people who abuse, misuse or overdose from strong painkilling drugs.

The CDC favours the use of non-opioid drugs for chronic pain, using the lowest possible effective doses of opioids and closer monitoring of patients.

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Themansaid better drug prescribing rules are just one part of the solution. He said there must be enough alternate treatment programs to help patients who have become dependent onopioidsto manage their pain.

"The problem exists right now. Those who are responsible, whether that is Alberta Health Services or the Alberta government or whoever it might be, I think need to take seriously the issue ofopioidabuse andopioiduse disorder and make it a high priority to ensure that patients and the providers looking after their patients have access to treatment facilities."

British Columbia's medical regulator has already moved to deal with what it calls "the public health crisis of prescription drug misuse."

Last spring the College of Physicians and Surgeons of B.C. approved standards and guidelines for safe prescribing that went into effect on June 1.

Theman said the Alberta college will host a forum next month on how to better address problems with opioid prescribing that will include physicians, Alberta Health, Alberta Health Services and other groups.