10 Nova Scotia doctors investigated for unusual opioid prescribing

Ten Nova Scotia doctors are being investigated for irregularities in their prescribing practices for highly addictive opioids, as a monitoring system documents over 5,000 patients receiving dosages higher than recommended levels.

The complaints were forwarded by the province's prescription monitoring system to the College of Physicians and Surgeons between Jan. 1, 2015, and last week, and include prescribing problems with painkillers ranging from fentanyl to oxycodone.

Kevin Lynch, the manager of the monitoring program, said complaints are based both on reports from the public and a "risk scoring report" from a database that monitors doctors' prescribing practices.

The "risk scoring report" system was launched in 2015, and Lynch says in an email there have been more reviews since that system came into being.

There were seven complaints forwarded to the college in the two years before the latest numbers.

The college's registrar wasn't available for comment, but a spokeswoman for the self-regulatory body said any discipline resulting from the complaints will be publicized on its website.

Dr. Robert Strang, the province's chief medical officer, said in an interview that the province has set up a committee to consider what to do about over prescribing of opioids by doctors. The province has had at least 49 deaths from opioid overdoses this year.

'Rigid standards' considered

In British Columbia where a public health emergency has been declared due to a surge in opioid overdose deaths the college has already adopted mandatory standards for doctors, including documenting discussions with their patients about the benefits of alternative pain treatments.

The rules also require doctors to prescribe the lowest effective dosages and have ongoing reassessments that include urine testing to ensure the drugs are ingested.

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Strang said Nova Scotia may consider similar measures, but will await the completion of national guidelines for prescribing opioids early in the new year.

"That's part of the discussion with the guidelines," he said in an interview.

"Do you make them stronger and have more rigid standards that needs much more approval and having to go through a much more rigorous approval process to go above certain limits? That's all part of what we have to look at."

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Concerns about doctors' prescribing habits came into the public eye earlier this year when a doctor in Bridgewater, N.S., was charged with drug trafficking. Police have alleged Dr. Sarah Dawn Jones provided 50,000 opioid pills to a hospital patient who never received them.

In addition, figures released to The Canadian Press last week indicate that for the first nine months of this year there were 5,248 patients in Nova Scotia receiving dosages considered to be above the "best practice" guidelines from the U.S.-based Centers for Disease Control and Prevention.

That's about eight per cent of all patients receiving prescriptions for the highly addictive drugs, though about one quarter of the high dosage patients are being treated for cancers that may require higher levels of medication.

Limits on prescribing

Thousands of Nova Scotians are on high dosages despite the college's May motion stating it is "best practice" to avoid doses equal to or over 90 milligrams daily for non-cancer chronic pain, as the U.S. centres recommended.

The milligram per day dosages are referred to as "morphine equivalents" the standard measure of potency used by physicians.

In British Columbia, the recently passed standards say daily doses equal to or greater than 90 milligrams "warrant substantive evidence of exceptional need and benefit."

Benedikt Fischer, a senior scientist at the Centre for Addiction and Mental Health in Toronto, has said the dosages being documented by the Nova Scotia prescription monitoring agency are "very high."

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