Rethink on opioid over-prescription

Doctors’ group aims to balance pain relief needs with abuse concerns

SASKATOON The College of Physicians and Surgeons of Saskatchewan is striking a new tone in its efforts to reduce opioid over-prescription as it walks a “fine line” between preventing opioid abuse and still providing opioid medications to patients in need.

Data from the college’s prescription review program shows the quantity of most opioids prescribed in Saskatchewan has been steadily decreasing since 2016 as the regulatory body and government attempt to curb overprescribing and diversion of pharmaceuticals.

However, Dr. Karen Shaw, the college’s registrar and CEO, said she wants to avoid the “aggressive” pivot away from prescribing opioids that has been taken in jurisdictions like British Columbia, which some critics say resulted in patients who needed or were dependent on opioids going untreated or resorting to dangerous illicit drugs.

“We’ve taken a slightly different approach than the rest of Canada in some of this,” Shaw said. “We’re saying, ‘We’re supporting you. We’re not here to criticize unduly. But if there’s something we have that you don’t have in terms of information, we want to provide that to you.’ ”

Opioids are prescribed to treat pain. They’re also prone to abuse and often sold in the illicit drug market.

Dr. Peter Butt, an addictions specialist at the University of Saskatchewan, said prescription drugs — not illicit fentanyl — are the main cause of overdoses in the province.

Over-prescription has contributed to that problem. Last year, a provincial auditor’s report found 441,354 opioid prescriptions were filled in Saskatchewan in the 201819 fiscal year, well above the national average. It also identified potential for patients to cheat the system by getting refills or prescriptions from multiple doctors.

Concerns about over-prescription have risen with rates of opioid overdoses, which have killed more than 14,000 Canadians since 2015.

Butt and Shaw said over-prescribing is the result of long-standing misconceptions about the “legitimate role” of opioids in pain management. A report from the Canadian Institute for Health Information found an eight per cent drop in opioid prescription rates in Saskatchewan, Alberta and British Columbia from 2013 to 2018.

Shaw said that’s due to better physician training about other options for treating pain.

In some cases, opioids may be an appropriate option, while in others, “de-prescribing ” could be medically risky, she said.

Butt said there’s a “fine line” between managing patient pain and preventing abuse.

The program sent 6,925 letters in 2016, warning doctors that a patient may be receiving controlled medications from three or more sites in the same month.

In 2018, the program staff sent far fewer letters — 298 of them — warning doctors about poor prescribing habits. However, the program hired more staff and participated in more events to share best practices with physicians, Shaw said.

A prescription review program advisory committee has also been struck, Shaw and a ministry spokesperson said.