Opioid expert supports Yukon coroner's recommendations on prescriptions

The chair of a national academic centre on pain managementsays he agrees with recommendations made by Yukon's chief coroner in the wake of two deaths from mixed drug toxicity.

In both cases, the patientshad obtained large quantities of prescription painkillers, either by refilling prescriptions early or visiting multiple clinics and pharmacies.

Chief Coroner Kirsten Macdonald has recommended setting up a prescription information system where doctors and pharmacists can requestup-to-date records ofmedications prescribed and dispensed to patients. She has also recommendedthat certain prescriptions be sent directly from doctors to pharmacies and bypass the patient.

Dr.Norm Buckley, chair of the Department of Anesthesia anddirector of the Michael G. DeGroote National Pain Centreat McMasterUniversity in Hamilton, Ont.,says the problem of opioidabuse and how to monitor prescriptions for the painkillers is a national concern.

Buckley says doctors sendingcertain prescriptions directly to pharmaciesisalready happening in many parts of Canada.

"At our own pain clinic at McMaster we fax directly to the pharmacy. We no longer give out paper prescriptions for anything," he says.

Triplicate prescriptions are so named becausethey are made in three paper copies. One is for the patient, another goes in the doctor's recordsand another is sent to an overseeing medical body.

Buckley says the idea is a good onebut the paperwork often isn't fast enough.

"The problem as has played outis that it doesn't mean the patient couldn't get several different prescriptions," he said.

"That triplicate in paper from may not be reviewed for quite some time. You don't get quick enough feedback to know this is happening today."

Buckley says a digital systemprevents also errors "because it comes off an electronic system, it's also printed clearly, so you avoid the problem of reading physicians' handwriting."

At our own pain clinic atMcMasterwe fax directly to the pharmacy. We no longer give out paper prescriptions for anything-Dr.Norm Buckley, chair of the Department of Anesthesia atMcMasteruniversity

The doctor is blunt when describing the problems with narcotic painkillers.

"We have two groups. One is the thieves and the people who want to simply deceive you for medication they can resell. The other group (addicts) is in some ways more trouble," he says.

"If somebody actively sets out to deceive us, the likelihood of being successful is pretty good," he says.

One initiative he mentions is that pharmacies in Ontario require photo ID for some prescriptions. Another is a computer network seen in B.C.

"Some of my colleagues in B.C., when they run their clinic, they have the program open in the corner. When the patient comes in, they can find out all the medications the patient is current receiving when they were last prescribed and what dose they received," Buckley says.

The Yukon government says it is creating a new electronic health record system for the territory thatwill include a prescription registry. The new system could be in placewithin 18 months.