Opioid prescription proposal worries patients

Proposed new rules to rein in doctors overprescribing opioid drugs could wind up doing more harm than good, particularly for Albertans who use such medications to manage chronic pain, a patient advocacy group says.

“People are terrified they are going to lose their medication and be back into a life they had before,” Barry Ulmer, executive director of the Chronic Pain Association of Canada, said Tuesday.

Ulmer said the proposed regulations from the College of Physicians and Surgeons of Alberta, though well intentioned and aimed at reducing addiction and overdoses, are too heavy-handed and fail to consider pain sufferers.

Proceeding with the regulations could see more people turn to alcohol or street drugs, increased suicides and fewer doctors willing to treat pain patients, he said.

Ulmer made his comments the same day the college hosted a forum with health and law enforcement officials to discuss the provincial opioid crisis and the role of prescription medications.

At the centre of the discussion was the college’s new draft standard of practice, which pushes physicians to adopt more caution and care in their prescribing habits for patients requesting oxycodone, morphine or other opioids.

Among other safeguards, the proposed standard calls on physicians to prescribe the lowest possible dose — consistent with new U.S. guidelines that warn against dosages that exceed 90 morphine milligram equivalents a day. That’s well below the current Canadian recommended maximum of 200 milligrams daily.

Evidence suggests Alberta doctors are among the highest opioid prescribers in the country.

From 2012 to 2015, opioid prescriptions increased by about 100,000 in the province and there are thousands of patients who have been prescribed doses of more than 200 milligrams, the college said.

College registrar Dr. Trevor Theman said one of the main goals of the proposed rules is to ensure doctors aren’t helping to create a new population of patients who suffer from opioid-use disorders.

As for those who have been taking opioids for years, he said the intention is to ensure they are treated as diligently as possible, without leaving anyone in distress.

“For some that might mean weaning them off, for some that might mean addictions treatment, for some that might mean being seen in a proper chronic pain setting or using other modalities to treat their pain,” he said.

As written, the proposed standard doesn’t forbid a doctor from prescribing a daily dose of more than 90 milligrams, but says any such decision must be carefully justified and documented.

While Theman suggested opioids are not as helpful as many patients or physicians believe, Ulmer said the college is dismissing the views of sufferers who best know how to manage their pain.

He said most chronic pain patients tried a variety of other treatments before they found opioids were the only thing that provided some relief.

Even without an outright ban on higher doses, the college will have doctors scared to continue such practices, Ulmer said, adding he believes the new U.S. guidelines are based on scant and flawed research.

Ulmer hopes to see some modifications to the proposed standard before the college votes on it next year.

People are terrified they are going to lose their medication and be back into a life they had before.