EDITORIALS Tough fentanyl response needed
Adesperately sad campaign kicked off this month in Saanich. A group of mothers called for national action, after their children died taking the painkiller fentanyl. They want federal and provincial health ministries to relax access to narcan, which acts as an antidote to opioid drugs, fentanyl among them. Currently, the drug requires a physician’s prescription.
The B.C. Health Ministry does give narcan kits to people taking opioids in certain circumstances. The ministry also supports allowing pharmacists to dispense the drug at their own discretion.
Yet there were 12 fentanyl-related deaths on Vancouver Island in the first five months of 2015 alone, and fatality rates across the country are growing.
It can do no harm to make narcan more widely available, and will almost certainly save lives. But the real question is how young people gain access to prescription drugs in the first place.
While some are stolen from drugstores, or from family members who have a prescription, the majority reach the street through sheer carelessness on the part of physicians and pharmacies.
In B.C., addictive drugs are supposedly tightly controlled. When a physician writes a prescription for fentanyl, it’s flagged on the ministry of health’s Pharmanet computer system, along with the doctor’s name.
The B.C. College of Physicians and Surgeons routinely searches these entries. Physicians who are overprescribing controlled medications are asked to account for their actions.
But here is the problem. The vast majority of drugs that end up on the street are prescribed to individuals who were using a stolen or fake ID.
Since most are smart enough not to make repeat visits to the same doctor or drug store, the college’s search program doesn’t detect an oversupply.
However, that is not the end of the story. Far from it. There is another cog in this wheel.
Physicians and pharmacists are supposed to verify the identity of anyone seeking or filling a prescription. That’s particularly the case when addictive medications are involved.
Yet as a huge investigation in Vancouver has just revealed, this requirement is frequently ignored. The inquiry focused on a woman who used a friend’s name and address to fill 250 prescriptions for the opioid oxycodone.
Over a five-year period, the woman was dispensed 23,000 pills. That amounts to more than 200 milligrams a day — potentially enough to kill a teenager.
The investigation, conducted jointly by the College of Physicians and Surgeons and the B.C. College of Pharmacists, found 46 physicians and 104 pharmacists guilty of deficient prescribing or dispensing practices. Basically, they failed to ask for photo ID that would have revealed the con, and settled instead for some flim-flam.
Moreover, this investigation focused on just one scam artist. It seems highly likely there are hundreds, perhaps thousands more plying this deadly trade who have not yet been detected.
What makes this situation all the more unconscionable is the enormous amount of time and money the Health Ministry spent to create its Pharmanet program. A database that was designed specifically to prevent fraud goes for naught, thanks to professional neglect.
Caution is required here. Opioids such as fentanyl are essential for patients who have terminal cancer, or other ailments that cause extreme pain. The last thing we want is to discourage physicians from the proper use of these drugs.
But it is clear a full-scale crackdown should be launched to prevent what might well be an epidemic of over-prescribing and lax dispensing.
And tougher disciplinary measures are needed. None of those 150 practitioners identified in the Vancouver inquiry lost their licences or suffered any financial penalty.
Considering that people died, in part, due to this carelessness, a firmer response is warranted.