Responsible action on opioid prescription

Re: Managing pain by proper opioid prescribing is now in danger, Nov. 6.

Dr. Ellen Thompson states that information provided at the national “opioid summit” in Ottawa last year “resulted in an unprecedented crackdown by the Ontario College of Physicians and Surgeons on 84 Ontario pain physicians found to have been prescribing higher doses of opioids than the much-reduced limit now adopted by the College.” In fact, the College initiated 84 investigations because we had received potentially concerning information from the provincial Narcotics Monitoring System about their prescribing practices. New Canadian Guidelines that recommend prescribing lower dosages had not been released at the time these investigations were started.

The College has consistently stated that “understanding and questioning prescribing practices is not intended to discourage appropriate opioid prescribing, and we stress that it is our expectation that physicians who are the subject of an investigation will not suddenly cease prescribing to patients currently on opioid therapy as such an act would not be good medical care.” We are not asking physicians to stop prescribing opioids but, rather, to prescribe responsibly and to stay in line with best practices.

Dr. Thompson opined that “certainly a review of practices, and remediation where indicated, would have been constructive.” We completely agree and that is, in fact, the approach we’ve taken in the vast majority of these investigations where further action was necessary.

The College will take a remedial approach, whenever appropriate, to help physicians practise to current standards. Our goal is to support education and continued prescribing under supervision, where the physician’s capacity for remediation is apparent.

David Rouselle, MD FRCSC, President, College of Physicians and Surgeons of Ontario