Physicians’ college tightens regulations on prescribing opioids

Changes include providing documentary evidence, reviewing medication histories

Alberta doctors who prescribe opioids and other high-risk medications will soon be required to exercise more caution.

New professional rules designed to reduce addictions and drug misuse come into effect April 1, the College of Physicians and Surgeons of Alberta said Friday.

“Putting more checks and balances in place for these drugs will help patients and our members,” college registrar Dr. Trevor Theman said in a news release. “These drugs pose a significant health risk and physicians need to ensure they are prescribing responsibly.”

The changes will require doctors to adhere to a stricter process when providing patients with opioids, benzodiazepines, stimulants, sedatives and other medications with the potential for misuse.

Included are requirements to justify prescribing decisions with documentary evidence, and to review each patient’s medication history from Netcare, the Pharmaceutical Information Network or some other source.

The new regulations were crafted largely as a response to Alberta’s growing opioid crisis. While most of the province’s fatal overdoses have been linked to illegally made narcotics — particularly fentanyl and carfentanil — medication obtained through prescriptions is also playing a role.

A number of deaths has been directly linked to prescription opioids such as oxycodone and morphine, while other overdose victims who died from fentanyl initially became addicted to opioids through a prescription.

The college’s new regulations have specific rules for doctors who issue long-term opioid prescriptions for patients with chronic pain. In general, the measures call on doctors to increase their monitoring of such patients and to prescribe lower doses — consistent with new guidelines issued by the U.S. Centers for Disease Control and Prevention.

Specifically, the guidelines warn against dosages that exceed 90 morphine milligram equivalents a day and suggest careful consideration of the risks when deciding to exceed 50 milligrams daily.

According to college documents, some doctors have expressed worry the new requirements will be too onerous or impractical, and will reduce the time they can see patients.

The regulations have also been criticized by advocacy groups that represent patients with chronic pain, some of whom are worried they may lose their medication.

Theman said the rules do not forbid high doses of prescription opioids, but doctors could be required to carefully justify those decisions.