Medical Matters: Good prescribing practices begin with good education

Read time: 3 minutes

By Mr. Ed Jess, Chief Innovation Officer

As many of us have seen in the media recently, the opioid crisis continues to impact thousands of Albertans. In 2022 alone, there were over 1,000 opioid-related deaths in our province, the ripple effects of which continue to be felt throughout Alberta.  Although the overdose crisis has morphed into a contaminated drug supply issue, historic opioid prescribing practices are recognized to have contributed to the crisis.

Appropriate prescribing is critical to quality medical practice, public health and safe patient care. As such, I thought I would use this month’s Medical Matters to dive a little deeper into CPSA’s role in prescribing and some of the resources we have available to support regulated members, along with important changes to which prescribers should be aware.

I oversee CPSA’s Analytics, Innovation & Research (AIR) department, and one of our responsibilities is to provide support for all things prescribing. This includes administering the Tracked Prescription Program (TPP) Alberta, Alberta’s prescription monitoring program, which has been collecting data to monitor the use of prescription drugs prone to misuse in the province since 1986. Our team is comprised of data entry clerks, researchers, pharmacists and physicians, to name a few, who share data with the profession in several ways to encourage self-reflection and help regulated members identify opportunities for improvement. By providing these continuous quality improvement resources, we can help ensure patients receive safe and appropriate care.

As CPSA is a learning organization, we believe in taking an educational approach whenever we can. We support the safe and responsible prescribing of opioids and trust that, when given the proper information, tools and resources, regulated members will make safe, responsible clinical decisions in the best interests of their patients. Much like excess prescribing is irresponsible and dangerous, so too is abrupt discontinuation, abandoning patients or outright refusing to take on patients who require opioids.

We understand that prescribing opioids can be stressful and what works for one patient may not work for another. To set prescribers up for success, CPSA offers a number of resources, such as MD Snapshot-Prescribing. MD Snapshot-Prescribing, available in the CPSA Portal, is an interactive, self-reflective tool providing regulated members with relevant and timely information about their opioid, opioid-naïve, benzodiazepine/z-drug and antibiotic prescribing. This tool is not punitive, nor is it a report card. It is intended to increase prescribing awareness and, as a result, optimize patient care. MD Snapshot-Prescribing is customized for each recipient and produced quarterly, allowing prescribers to explore features such as long-term trending and customizable comparator groups.

In addition to MD Snapshot-Prescribing, physicians can also access TPP Alberta’s Opioid & Benzodiazepine/Z-drug and Antibiotic Prescription Atlases. These reports provide an overview of provincial antibiotic and medication use, which can inform policies, strategies and programs across Alberta. The 2021 Opioid & Benzodiazepine report revealed that just over 1.4 million opioid prescriptions were dispensed in Alberta that year. Further, prescribing for opioid agonist treatments (OAT) continued to increase—numbers for buprenorphine have tripled since 2016, while methadone prescriptions have almost doubled over the past six years. Good prescribing practices begin with good education, and having access to this detailed data can help prescribers deliver the safest and most effective patient care possible.

Following changes to Alberta’s Mental Health Services Protection Regulation, prescribers should be aware that, as of March 4, 2023, physicians are no longer able to prescribe a high-potency opioid narcotic for the treatment of opioid use disorder outside of a narcotic transition services (NTS) setting, with the exception of methadone, buprenorphine or slow-release oral morphine. Patients must be fully transitioned to an OAT excluded from the regulations (i.e., methadone, buprenorphine or slow-release oral morphine), or transferred to an NTS. For narcotic transition services support, information and referral to an AHS Opioid Dependency Program clinic, please call 211 Alberta. For information on CPSA’s OAT program, please visit our website.

CPSA’s Safe Prescribing for Opioid Use Disorder standard and accompanying Advice to the Profession have been updated to reflect the changes to the Government of Alberta’s Mental Health Services Protection Regulation. The updated standard was approved by Council on Feb. 23, 2023 and came into effect on Feb. 24, 2023.

We know that prescribing is a complex but necessary part of medical practice. If you have any questions or need support, our team is here to help. Please don’t hesitate to reach out to us at support@cpsa.ab.ca.

Mr. Ed Jess graduated from the University of Alberta in 1990 with a BA in Economics and Statistics. He has over 30 years of extensive and varied experience in the healthcare and pharmaceutical industries, as well as product sales, development and senior management. Mr. Jess joined CPSA in 2012 as the Director, Prescribing and Analytics, in the Continuing Competence Department. His current role is Chief Innovation Officer, in which he oversees CPSA’s Analytics, Innovation and Research (AIR) department, including Alberta’s Tracked Prescription Program (TPP Alberta), the Physician Prescribing Practices Program, and CPSA’s Research & Evaluation Unit (REVU).