Canadian physicians should be subject to mandatory continuing medical education in the appropriate prescribing of opioids—medications whose use now has become almost routine for treating chronic pain, the Canadian Medical Association’s annual meeting in Halifax was told yesterday.
Dr. Douglas Grant, registrar of the College of Physicians and Surgeons of Nova Scotia, told an educational session on the drugs that excessive prescribing of opioids like oxycodone, fentanyl, and hydromorphone for patients with chronic, non-cancer pain has become “an enormous problem.”
“With respect to opioids, there’s been in my view a general loss of awareness; a growing casual attitude about the risk of these medicines,” Grant said.
As doctors have become increasingly comfortable with prescribing opioids over the last two decades or so, he believes they’ve become less aware and concerned about their potential dangers, including the increasingly common risk of overdose death.
At the same time, there’s been a shift in patients expecting to be not only treated for pain but to be pain-free, he added.
“That’s created a positive feedback loop which I think has led to the present rates of high prescribing,” said Grant, noting Canada has the second-highest per capita usage of prescription opioids in the world after the U.S.
“I really think we’re at a point now where we have to consider mandatory CME [continuing medical education] about prescribing,” he stressed.
Doctors must have a number of continuing education credits each year to be considered medically-competent and to remain in good standing with their professional colleges.
“So the question we have to ask ourselves is: how do we get the toothpaste back in the tube?”
Grant doesn’t believe excessive opioid prescribing arises from “malignant” doctors who knowingly are contributing to the widespread legitimate and illicit use of the drugs.
Rather, it’s from physicians who take too casual an approach to prescribing the potent pain-killers.
“What I frequently see is undisciplined, unstructured, and arbitrary use of these medications,” Grant said, pulling no punches in his address to delegate-colleagues attending the session.
“Most of the time, this approach is employed by well-intentioned but weak-willed and under-informed physicians who have lost control of the patient-doctor relationship.”
Regulators like his Nova Scotia college can help physicians by pointing out how their prescribing practices stack up against those of other doctors in their province based on a prescription monitoring program, he noted.
Nova Scotia is one of the few jurisdictions in Canada with such a program, which allows doctors to check on a patient’s real-time medication history.