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Important information regarding opioid prescribing

From the Registrar, July Messenger 2019, Medical Matters, Messenger, Prescribing | Posted July 11, 2019
There has been recent media activity in Alberta about concerns from chronic pain patients and access to opioids. The messaging has stated that CPSA prevents or discourages physicians from prescribing opioids. We have also heard that some physicians have stopped prescribing opioids or have refused to treat patients with chronic pain, because they are afraid of losing their licence to practise medicine. Unfortunately these two situations are putting people’s lives at risk. As a profession, we all have a responsibility to work together to protect chronic pain patients and CPSA is here to support you.

We understand that many physicians feel poorly equipped to manage patients with complex chronic pain, particularly when our understanding of the role of opioids is constantly evolving. In times of change, messages are often conflicting or confusing, and it’s easy to feel ill-informed in providing care to pain patients. Our physician community needs to continue developing and sharing the best practices around opioid prescribing, and supporting one another in learning about and implementing those changes. Each of you are focused on providing the best patient care you can, and CPSA is here to support you.

As physicians in Alberta, we are all accountable for prescribing opioids appropriately. The MD Snapshot – Prescribing reports we provide are intended as an education tool to help you prescribe safely. I’ve heard these reports have caused fear in some physicians-this is not our intent. CPSA is here to work collaboratively with the Alberta College of Family Physicians (ACFP) to support you in the appropriate care and prescribing of all medications, including opioids, for chronic pain patients. It’s important to reiterate:

  • It is never appropriate to abandon a patient on long-term opioid therapy, or abruptly cut off or threaten to cut off the patient’s medication. Safely reducing long-term opioid medication requires expertise and support. Links to specialized clinics and resources for physicians are available on the CPSA website.
  • It is never appropriate to refuse to accept a patient because they have complex medical needs or use opioids. All Albertans deserve access to the care they need and physicians must treat all patients equally regardless of their medical condition.
  • Patients taking prescribed opioids should not be stigmatized. There are some medical conditions where opioid use is an appropriate treatment. Also, any person taking an opioid medication can develop dependence over time. This is a known risk of the medication, and is not the fault of the patient.

CPSA recently spoke with Dr. Cathy Scrimshaw, the lead of ACFP’s Collaborative Mentorship Network for Chronic Pain and Addiction, about the complexities of providing care for patients who use opioids for chronic pain. When helping patients effectively manage their pain, Dr. Scrimshaw suggests drawing on the strong relationships family physicians have with their patients.

“Talk to your patients with an open mind,” Dr. Scrimshaw recommends. “Reassure them that you don’t want to take away their medication today. Review their history to see if all avenues for pain management have been explored and whether their current medication may be causing problems. If you have concerns, tell them why and ask if they would consider tapering, or maybe trying a new treatment. Give them some resources to review. Then ask them to come back to discuss next steps.

“Chronic pain is complex but ultimately, it’s just like treating any chronic illness and there are resources available for physicians who need help supporting their patients.”

Read more about Dr. Scrimshaw and her work.

I would like to personally thank all physicians who are already providing excellent health care to your patients and commend you for your hard work and dedication. We value the exceptional work physicians are doing for Albertans. The ACFP and CPSA are here to support you and ensure you have access to any resources or information required to best care for your patients. You can reach out to ACFP at mentorship@acfp.ca or 780-488-2395 or CPSA at CC.Inquiries@cpsa.ab.caor 780-969-4935 for any further questions or concerns.

I also encourage you to check out the University of Calgary’s new course, Wise Prescribing and De-prescribing: Opioid Skills for the Frontline Clinician, that was developed in partnership with CPSA and AHS. There are free, self-learning online modules as well as small group workshops that will be held throughout the year.

Dr. Scott McLeod, MD, MPH, MPA, CCFP, FCFP
CPSA Registrar

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