If not opioids, what?

College of Physicians and Surgeons of Alberta CPSA, Designing Quality Blog 76 Comments

The medical profession was taught that opioids were effective and safe. But they’re less effective and less safe than we thought. They’re also contributing to a health crisis in our communities. Over-prescribing is part of Alberta’s opioid problem. As a profession, physicians need to own that problem, and help fix it.

CPSA recently hosted a unique prescribing forum for invited stakeholders to discuss solutions to the opioid crisis. Forum presenters included physicians, other health professionals and representatives from law enforcement, Alberta Health and Alberta Health Services.

Speakers addressed the broad issue of over-supply of opioids, both legal and illegal, identifying implications for physicians and other health care team members, and looking for opportunities to promote appropriate prescribing.

Discussions resulted in a five-point framework for action:

1. Focus on appropriate prescribing
2. Seek additional emergency (rescue) interventions for patients in crisis
3. Address addiction treatment
4. Explore other options for pain treatment
5. Seek access to more data and information

“I don’t think that I’ve taken from this that we need to take our chronic pain patients and rapidly dial back what they’re taking, what I’m taking from this is that how we need to prevent further addictions from developing in the first place. “Family Physician & Opioid Forum Audience Participant

What do you think should be first? Why? What’s at stake if we don’t?

Join the conversation & share your thoughts below in a comment. 

Work on the framework continues. Bookmark and check back to this page for progress. You are also invited to weigh in on the draft Standard of Practice on Safe Prescribing – out for consultation until December 12, 2016.

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Sam Shane

We appreciated the invitation to participate in this forum, but were disappointed in the overall content. It did not really shed much light on the situation as it relates to people with pain. The content seemed directly related to addiction problems and the illicit drug trade on the street. I would suggest everyone to get themselves check by an ENT specialist on monthly basis because you never know what cancer or allergy has struck up to you and usually it only becomes noticeable when it has grown to a stage where you have to face hard times to get rid… Read more »

Linda

Animals in pain are treated more humanely than people. When they are too old, or too sick, we put them down so they no longer suffer. Why do the doctors on here think that pain patients should have to endure their pain without adequate relief? I was doing just fine on opioids and was able to have quality of life – but now I’m in chronic pain. If it was legal, I’d seriously consider assisted suicide so I don’t have to continue to suffer. I have seen no adequate substitute for opioids. The NSAIDS I was prescribed have caused Crohn’s,… Read more »

College of Physicians & Surgeons of Alberta

Hi Linda,

Thank you very much for sharing your experiences with us. I have asked one of our Senior Medical Advisors to reach out to you to learn more. You will receive an email shortly.

Thank you!

Linda

I have chronic pain caused by a mistake during surgery. I’ve tried everything suggested to treat the pain – physio, acupuncture, massage, chiropractic, facet injections, Gabapentine, Lyrica, Duloxetine, NSAIDS, CBD oil. They either didn’t help or caused further health problems. The NSAIDS caused Crohn’s, I’m allergic to ibuprofen, and had side effects from gabapentin. The only thing that helped were opioids. I felt well enough to have a fairly decent quality of life, go back to work part time and do aquatic exercises. I took the opioids responsibly for 7 years – then my doctor quit her practice. I couldn’t… Read more »

Lynda

One more thing… I have read and been told by my GP that the College won’t let me or the College sent me a letter about you. Jesus what the hell do you guys do? Sit on a throne and act as a narcissistic God? I think the College should really monitor how long it takes to get certain services. People die waiting to see a specialist. How about let good doctors continue to be good doctors , how about teach doctors about trauma, ya know the kind of trauma that happened to the indigenous peoples. Actually now that I… Read more »

College of Physicians & Surgeons of Alberta

Hi Lynda,

Thank you for taking the time to read and comment on our blog post. We’ve asked one of our Senior Medical Advisors to reach out to you directly by email to learn more about your experiences and discuss your concerns, You will receive an email for us shortly.

Lynda

Wow I really can’t believe what I’m reading , you may not know Dr. Hauptman but I can assure you … he worked with patients on a holistic approach. Time and time again he told me exercise, spiritually and quit smoking. He says it like it is And never ever over prescribed. And for the record my GP did nothing regarding my opiate prescriptions without first getting it from Dr. H. The Alberta College of Physicians and Surgeons don’t make the laws in the land and they have no business interfering with a mans profession especially when he’s been nothing… Read more »

Lorie

Hello I have been reading some of the comments and I see the struggles ppl are having. And I can relate. I am a nurse with a back injury. I can’t get help. The only thing I’ve ever gotten is more opioids. My doctor is probly scared also. I need help. Is there anyone here that can help me. I need to get into a pain clinic in Alberta and possibly have a consult with a surgeon. Maybe one can help. I don’t know. But these opioids. Are about to kill me. And I cannot find help. I have spent… Read more »

Scott McLeod

Hi Lorie,

Thanks for writing in. I will have one of our Senior Medical Advisors reach out to you.

Scott

Lise

Omg why are you thinking? Your trying to punish pain patients for the opiate crises ! I suffer from Chronic Pain!!! I hate having to take meds period ! I’m not stupid I know about side effects? Do you think for a nano second that is way of life is fun or that we get high of pain meds no! You have lumped us with street addict not faith or just, SHAME on all of you !

Lynn lagace

Pretty soon going to drug dealers is going to be the only choice. In a small town of 5 doctors n hospital won’t prescribe any pain medication. Not even Tylenol 3. For migraines, take Advil with a glass of water. Don’t need to be a doctor to know how painful migraines are. It’s more or less refusing to treat you. Doctors should not be allowed to control the hospital n treatment. And I don’t mean opiates. How can they refuse pain medication? If in serious pain guess people will buy it from drug dealers. It’s shameful but how else would… Read more »

College of Physicians & Surgeons of Alberta

Hi Lynn,

Thank you for your comment. One of our Senior Medical Advisors will be reaching out to you by email to learn more about your situation.

Mary Marlene Gaber

I sincerely thank the CPSA , especially “☆☆☆☆” for taking an interest in my personal situation regardless of the outcome of this investment of time. I am aware the CPSA have no influence on my primary care physician. My situation these last years and likely the years ahead will continue to be challenging but I cannot refuse to give up “the fight” despite the odds against me. — I am aware , many with chronic , debilitating , disabling pain , such as I feel – the devastating loss of freedom of movement as well as career, finances , social… Read more »

Mary Marlene Gaber

I have been so dissatisfied with the.medical.profession for years. Now that I am no longer on those.medications that made me incapacitated due to S/E, I have been prescribed a suboptimal dose of medications. Dr. –“If I prescribed anymore , I have to write a letter to the CPSA.” Frig , i would be happy to pay the $60 to write the letter but they cannot charge for this letter. What is.more important , keeping.me handicapped or providing.me with a dose where I can go swimming and do floor exercises to improve my spine. So – the.following questions which will likely… Read more »

Scott McLeod

Hi Mary, Thank you once again for writing to us and expressing your concerns. The CPSA does not require physicians to write a letter to us informing us of prescription changes so this sounds like a barrier that we can help remove. I understand that someone from the CPSA has reached out to you in the past so I will ask them to reach out again to provide you with some support. The questions you ask are important ones. The challenge for us is that we know these are risk factors that come with the diagnosis of chronic pain itself.… Read more »

Mary Marlene Gaber

Kind thanks , Scott , for responding to my post. I did respond further as so many feel helpless with controls of their ability to function outside their “grasp” or ” control”. I did not mention the individuals name as I do not wish to have this person espoused to a “barrage” of personal calls thinking that an individual’s care can be altered thus the true statement that the CPSA cannot influence a primary physicians personal care plan on their client. I am aware many “hands are tied “, not just those that suffer and the medical field is doing… Read more »

Mary Marlene Gaber

Have managed to obtain an apt with my primary care physician next week when my son visits from Calgary for the sole.purpose of attending the apt with me. It is sad he has to take time of work and travel to Edmonton to accompany me to an appointment. – His goal is to have me functioning sufficiently to keep the house clean so I can sell it and.move into the same.condo complex or nearby so.someone is nearby in the event their is a crisis or even death as I have.outlived my close siblings. – just.put me on the.medications that work… Read more »

College of Physicians & Surgeons of Alberta

Hi Mary,

We appreciate you taking the time to read and comment on our post. We have asked one of our Senior Medical Advisors to reach out to you directly and be available to answer questions or discuss concerns you may have about your ongoing experience with chronic pain. You will receive an email from us shortly.

Thank you.

Mary Marlene Gaber

Since my pain medications have been restricted to none my life has become just existing – I have become unable to complete housework , have difficulty meeting ADL , groceries shopping is rare ( done by friends ). Most importantly I have NO quality of life. I was placed on Gabapentin and had side effects of loss of balance ( not good 63 year old with spinal issues ). Loss of consciousness in 30below weather. My neighbor witnessed this and woke me. Severe side effects from Sublozone for 3plus months to total inability to urinate , then edema plus many… Read more »

Hugh Gilliat

My replies keep disappearing, so here goes again. Despite what your prepared response says, the reality is that the College is going after doctors who prescribe opioids. I have been waiting three years to see a specialist, I doubt I will ever hear back from them to be honest. My parents are currently trying to send me to the states because of the situation here. Currently I don’t get enough medication to cover the day, I bring this up every time and the response is always the same “the College won’t let me.” I have lost my career and I… Read more »

Dr. Monica Wickland-Weller

CPSA’s Continuing Competence program is in place to provide physicians with support and educational resources to help them manage their practice. Our interactions with physicians are collaborative and collegial, and physicians are encouraged to contact us if they have questions or concerns about their prescribing practice. CPSA works to support and reassure physicians in their clinical decisions and physicians are expected to use evidence-based practice guidelines to help them make their clinical decisions. CPSA does not prevent physicians from prescribing any medications that are justifiable and appropriate based on the individual patient’s condition and needs.

Dr. Monica Wickland-Weller

Should a physician’s practice circumstances change for any reason, we support and assist the physician in transitioning the care of their patients to other physicians—this is to ensure continuity of care for the patients and avoid having patients’ medications abruptly discontinued. Physicians who have agreements with CPSA for any reason may choose to share information about the agreement with patients or colleagues as they feel is appropriate or necessary. Any concerns about pharmacists or pharmacies should be directed to the Alberta College of Pharmacists. I encourage you to continue working with your family physician to address your medical concerns or,… Read more »

Mary Marlene Gaber

Hugh , you are blessed to have a support system in place despite the severe losses you have experienced. I kind of wish there was a support system in place where , we , as suffering lay persons , could share our trials and tribulations. This does not seem to be possible as our posts omit our full names , towns and/or computer addresses. I think this would likely be beneficial as most other groups with physical issues such as cancer , MS , and a variety of other physical ailments have this in place. I would not mind hosting… Read more »

Mary Marlene Gaber

Note : hosting would.only.occur on a good day which are far and few between as I have problems sitting but it is a good idea.

Hugh

It’s appalling how you doctors are acting. I am a chronic pain patient who uses opioids to function. If I didn’t have that medication I would not be able to live any semblance of a life. You supposedly “learned” doctors fail to see you are contributing to the fentanyl problem by cutting off patients who have been responsibly using opioids for years. It’s absolutely shocking how terrible you are treating us. I hope you read this next part and take it to heart: None of a you will ever make a difference in the amount of drugs on the streets,… Read more »

Dr. Monica Wickland-Weller

Thank you for sharing your experience and concerns with us. Our message to physicians has consistently been that it is not appropriate or acceptable to reduce prescription opioids abruptly in patients with long term stable use of opioid medications for chronic pain. We do not support tapering or reducing opioids simply to meet the current guidelines (thresholds). Any reduction in an opioid dose should only be done in the context of the patient’s medical condition, functional goals and individual needs. This is a clinical decision between the physician and their patient. Prescription opioids have a valuable and necessary place in… Read more »

Hugh Gilliat

Yeah, you all keep parroting that. But the reality is you are going after doctors who prescribe pain medication, so don’t sit there and copy-paste a prepared response comprised of lies. If you truly do care about people, then why the gag order on Dr. Hauptmann? This is Canada, why are you censoring people? What about all of his patients? You just said you didn’t support tapering or cutting off and yet you just did that to almost a thousand people… You will be responsible if any of those people commit suicide, do you even care? Or have you all… Read more »

Hugh Gilliat

I’m not sure what happened, but my last reply seems to have vanished. What you are preaching is not what you are practicing, the college is acting as judge, jury and executioner towards doctors who prescribe opioids. Also, why the gag order for Dr. Hauptmann? This is Canada, why are you censoring people? Don’t you get how messed up that is? You said you don’t support tapering or cutting off, but you did just that to a thousand people when you closed his clinic. If any one of them commits suicide, you will share some responsibility for their death. I’m… Read more »

Mary Marlene Gaber

I do not know the “story” of this Dr. HAUPTMANN????? Please send to my address and hopefully my cell phone will.work so I can learn about it.
I hear you loud and.clear. I know of some who have committed suicide do to the many losses in.life d/t chronic pain – health, finances , social.life , etc etc. Also the stress of increased pain and having no control over your.life as it was placed in the hands of others.

Lise Sitybell

I’m really disappointed to see a witch hunt going on against pain management doctors currently helping patients with chronic pain. I have osteoarthritis as well as fibromyalgia and have tried antidepressants, T3’s and T4’s, as well as various other pain medications. Currently I am on a low dose of oxyneo 10mg 2X daily and Percocet for break through pain which I use when I can’t get much relief. I refuse to ask for higher doses I know the risks and I abide by what my Dr tells me for my well being. I am pro active in my health I… Read more »

Dr. Monica Wickland-Weller

Thank you for sharing your experience and concerns with us. We have worked collaboratively with community physicians who provide management for patients with chronic pain conditions to support and provide them with educational tools and resources to allow them to provide safe care to their patients.
The Alberta College of Family Physicians has formed a Collaborative Mentoring Network to support physicians in the provision of chronic pain management. We are supportive of programs like this and encourage physicians to participate.

Sheilagh

I was the first patient in my physicians practice to be “tapered to the threshold” I agreed to do so because I despise meds, although I require them as no other therapy has worked for me. I’ve been through the pain clinics, tests, pokes and prods. I’ve been the example to newcomers to the pain clinic of how backs should never feel. Through work and very careful consideration and consultation with the pain clinic my doctor there and I worked me up to a long acting morphine dose of 120 mg/day split in 2. In addition I’d have 20 mg… Read more »

Dr. Monica Wickland-Weller, Senior Medical Advisor

Thank you for sharing your experience and concerns with us. Our message to physicians has consistently been that it is not appropriate or acceptable to reduce prescription opioids abruptly in patients with long term stable use of opioid medications for chronic pain. We do not support tapering or reducing opioids simply to meet the current guidelines (thresholds). Any reduction in an opioid dose should only be done in the context of the patient’s medical condition, functional goals and individual needs. This is a clinical decision between the physician and their patient. It has been our experience that some physicians may… Read more »

Dr. Monica Wickland-Weller, Senior Medical Advisor

I would appreciate the opportunity to talk with you about your concerns and how we may be able to help and support your physician.

Please feel free to contact me at 780 969 495. I will look forward to speaking with you.

Greg

Lot’s of interesting stories here, all of which I can relate to in many ways. Your’e not alone with your frustrations. I’ve broken both my legs, had both ankles Evans Procedure(ligament replacement), spleen removed, double hernia, 3 spinal surgeries, first two were discectomies, third one was L4/5 S1 seven hour fusion. My family doctor is now feeling the outside pressure of prescribing me pain management medication. He claims now that the barely adequate 5 percocets per day that i space out throughout the day, is too much. This is ridiculous in my opinion. He told me straight up that he’s… Read more »

monica wickland-weller

Thank you for letting us know about your struggle. What you have described would not meet our expectation of professional behavior and we are happy to offer our assistance to resolve this. We will reach out to you directly.

Wayne

I posted some months ago about the dire need for more treatment options.  For chronic pain patients falling between the cracks and for opiate dependent addicts. I believe a few more opiate based treatment options will be helpful and can save lives. After reading my comment, I sincerely hope the College would consider this seriously enough to bring it up to politicians and those with the will and political power to make it happen. It could save lives and research has shown it helpful in other Europe. The College must have a say in the so called opioid task force… Read more »

Dr. Karen Mazurek, Deputy Registrar

Dear Wayne – thank you for sharing your comments. We are very much aware of the risk of patients who are dependent on opioids turning to illegal drugs to replace prescribed opioids if their dose is reduced too fast. The welfare of the patient has to come first. We have been very explicit in our advice to physicians and the public about this. It has never been our position that physicians cannot provide opioids to a patient or that they cannot exceed 90 OME. We have advised physicians to consider a reasonable taper for patients on high doses to the… Read more »

Mary Marlene Gaber

The pain management doctor I saw that placed.me on Subozone which I suffered severe side effects had me go through a five day withdrawal which actually ended up seven days as the initial dose was minimal. I have tended to drug addicts and never have been so disregard full of their health and welfare. A 63 year old living alone with mobility issues and few clothes ( as unable to shop ) put through full withdrawal. That is inhumane esp since I could have commenced the.medications the next day. I hear you loud and.clear on the.other issues , Wayne. Wish… Read more »

RicardoH

Thank you for making my life even more miserable than it already was. The day before my birthday in 2014, I got horrible pain in my right leg and then my left leg went numb.  I thought it was a bad case of a herniated disc and since I had a discectomy back in 1984, I was concerned but not panicking.  Unfortunately, the diagnostic was much worse, I had Cauda Equina Syndrome.  2 herniated discs damaged my spinal cord and left me unable to walk and bladder/bowel incontinent.  I went from exercising, working, having a normal life one day to… Read more »

RUKHSANA AMEEN

Our target is to relieve the suffering, it is seen when the patient needs medicine especially with musculoskeletal issues, reorder is a problem. I have attended one seminar on pain management, I got the home message for me, my target is to bring my patient to its baseline function, monitor him regularly, manage side effects of narcotics and NSAID. Once close to baseline, supportive therapy, physiotherapy, gradully taper dosing Communication, understanding of the disease, dr.patient relationship definitely matters. In my opinion for reordering prescription is a unecessary burden to ER and to the pocket of the patient.

Mary Marlene Gaber

I am sincerely sorry for the dilemma that you are forced to endure as the controls have been withdrawn from your life. I hear you as I am just existing -not living and my family.members have died. I sincerely hope you have family to support you during this lengthy distressing chapter in your life. It is indeed difficult to receive diagnostic tests when one is in severe pain and experience lack of.mobility that they are unable to transport themselves to the office where the tests are to be.completed. I hope you receive compassion ate care from the.the . medical profession… Read more »

GLYN AXWORTHY

I have had restless leg syndrome since the early 80’s. It started out fairly mild for several years but became increasingly worse. I put up with the annoying pain and discomfort.  In the early 90’s it began to travel up into my arms and now is a serious problem. The flailing of of any of my arms or legs IS NOT controllable and is now such a violent movement that my shoulder, elbow or legs joints hurt a lot when an uncontrollable jerk occurs. I have come close to knocking people out if they are to close when the jerk… Read more »

Habenom

As I read through all the comments, it appears to me that CNCP and acute pain due to the different cause haven’t been addressed up to standard on the evidence based practice by lots of practitioners perhaps due to lack of resource or knowledge based awareness. Pain is complex and as it is, need to be individualized by the expert in the field. Lots of Gp’s will have the understanding of pain simply the route of peripheral sensitization to central sensitization as Descartes’ view of pain. However, pain’s complexity is far beyond that explanation of ascending and descending orders of neurons. It has first pain pathway-the anterior cingulate cortex which is… Read more »

Mary Marlene Gaber

Some people have a high tolerance to pain medications even if.not received previously. When first.placed.on pain.drugs – I was ashamed. Now I am aware I require same.for.some.semblance.of.quality.of.life.
Seems “drug addicts” are receiving compassionate care while those who did not choose disabilities are suffering unless the doctor is willing to write a letter ( on their own free time ) on behalf of their clients therefore advocating for their client.
Great.post – Habib on ( lost your.place )

ron

As a long term opioid patient that has chronic pain issue what am i to do to continue my job as a bricklayer as i keep getting reduced on my medication and soon will not be able to deal with the pain to keep working.I understand there is a problem but i feel like i am being punished for an epidemic that i have nothing to do with. All i want to do is be able to provide for my family which i will not be able to do with the dose of medication somebody sitting at a desk tells… Read more »

Res Steven

Opioids work for chronic pain and so does cananibis. But it is not a first line treatment.  And the least effective dosage needs to be used. I have patients on opiods who are more functional and able to do function well. These are people who have tried or have been intolerant of: gabapentin, lyrica, elavil, tramdol, tylenol, advil and topical medications.  The other options I have found useful is for patients that have more locazlied problems is to refer them for trial of regenerative injections such as prolotherapy or PRP at clinics such as ipax pain clinic or healthpointe. These resources have… Read more »

Wayne

 I wanted to address other treatment options.  I don’t know where else,  on the website, to post this. This seemed to be the closest topic. I keep hearing mention of better availability of opioid treatment and maintenance programs. The maintenance medications we have, while very helpful,  do not work for all patients. We NEED more options!  Some find subtutex isn’t strong enough and while methadone may be, it has serious side effects in some people.  I have seen many patients quickly gain excess weight on methadone. (for some patients this is in direct relation to methadone and has nothing to… Read more »

Dr. Karen Mazurek, Deputy Registrar

Thank you for your comment. I agree that we need to avoid the unintended consequence of chronic pain patients turning to illicit opioids. The CPSA has been very clear in our messaging to physicians and the public that opioids should not be abruptly discontinued or rapidly tapered. Your point regarding options for opioid dependence treatment is well taken.

William Petty

My doctor arbitrarily reduce my opiod  dose by 10 %, and advised me he will continue 10 % reductions on a monthly basis, with a final goal of 30% permanent reduction. I was given no choice in the matter. I  am already experiencing extreme discomfort, to the point where I am now in serious pain for over 50% of my day and sleep in my chair because it is too paiful to raise my legs onto the bed. I have no wish to participate in this program and feel very strongly that I should have been given a choice. I’m… Read more »

Dr. Karen Mazurek, Deputy Registrar

Thank you for your feedback, William. Current best practice recommendations support that there are a number of scenarios that, to ensure patient safety, a taper of opioid medication is appropriate. While a decrease of 10% of the original dose per week is in keeping with best practice guidelines, every patient is different. The best course of action is to talk to your physician about your symptoms. You may require a slower taper and/or an adjustment of non-opioid medications and non-pharmacological therapy to manage your symptoms as the opioid is gradually reduced. I hope that advice helps you and others who… Read more »

Chris

You should; this is state sanctioned torture!

Hubert Kammerer MD

Physicians have to take some responsibility for the position we presently find ourself in, with regards to opioids. We have actively contributed to the pool of addicted patients some of whom are now overdosing on Fentanyl and other opioids in ever increasing numbers.  I remember years ago, attending lectures sponsored by the pharmaceutical industry where “pain specialists” would tell us that opioids were safe and effective in non-cancer pain and the likelihood of someone in pain becoming addicted was low. We were told that chronic non-cancer pain is greatly under treated and we were letting our patients suffer unnecessarily by… Read more »

Info@CPSA.ca

Thank you for your question, Jahn. Discuss your concerns about your medications with your new physician, understanding that our knowledge of medications and medical conditions is constantly changing and becoming better. It is important to reevaluate care regularly and it may be necessary to make changes that will bring about the safest and most effective patient care based on a current assessment of your clinical needs. Anyone looking for a new family physician in Alberta can search our website (http://www.cpsa.ca) for those in your area accepting new patients. Search using key words that describe your condition for a more specific list.… Read more »

Jahn

What happens when your general practitioner retires and has been giving you the same medication for 7 years. And you look for a DR And that doctor and many other doctors will not prescribe those drugs to you? What does a person do?

Khaled Rajab

Chronic pain is complex issue especially  when  there  are mental health comorbidity  like anxiety depression, insomnia or addiction  as I appreciate the CDC , the Canadian  guidelines  for chronic non cancers pain , which gives more insight for family physicians to follow , and in order to follow these recommendations  , so should be paired with other modalities of treatment to be available to those patients , like psychologists CBT  for pain , physiotherapy  , mental health counseling for anxiety  depression and insomnia , more access to addiction clinic  as I see it , it is not only the family… Read more »

Rick Zabrodski

My 35 years of practice in ER, family med, and occupational medicine has taught me that acute pain is an healthy response to inflammation/injury, and chronic pain  while occasionally related to a pain generator such as hip OA, is  more often a much more complex issue related to CNS sensitization, better viewed as a chronic illness, what I call “the dark side” of neuroplasticity.  It is not a character flaw.  The challenge has been providing treatment with both hands tied behind my back. Drugs never fixed anybody with chronic pain.  Unfortunately, while I can order a 600 dollar CT scan… Read more »

Sonya Regehr

Well said! I work on a reserve where I deal with patient expressions of pain frequently. There are just so many barriers to the multidisciplinary care they require.

Patrick

As a new doctor in Alberta who has come from Ireland there is a marked difference in prescribing opioids here. It certainly does appear more prevalent. Unfortunately as a doctor I think it is doctors that are largely responsible for this problem. Patients have expectations of a pain free existence which is just not realistic for many people. I think we must inform people that opioids really are more harmful than beneficial except in certain circumstances where all other options have been exhausted. In my own cohort of patients I seem to have inherited problems that may have been avoidable.… Read more »

Owen Schwartz

My suggestions are to look for the non physical roots of pain as well. Much pain is rooted in fear and a feeling of helplessness.

Psychotherapeutic support ought to be a mainstay for all chronic pain

Everyone would benefit immensely by learning meditation and breath techniques which ought to be a cornerstone of Rx. Forinstance detachment as taught in Mindfulness is an essential skill

 

Kate Bisby

As a doc who works in addictions, I would just like to high-light that gabapentin and muscle relaxants are readily abused (with a street value), and as such, should be monitored for early fills, doctor shopping, etc…

Dr. AH

I believe we need to advocate for adjuvant and non-pharmacotherapy treatments for pain to be covered by low-income benefit plans.  There also needs to be more fundamental discussions with patients and in our society about expectations around chronic pain and addressing underlying mental/emotional/social stressors.  We do have a responsibility as healthcare providers to treat people holistically and not put them at risk for further harm with reflexive prescribing, but then we need to have alternatives that we can offer. 

Neil Heard

Indomethacin or diclofenac suppositories appear to be quite helpful for post op pain, renal and biliary colic ( assuming renal function to be normal). Over and above the cited problems of  diversion, potential overdose and  addiction, one is concerned about impairment, whether or not marijuana and/or alcohol and other substances are added to the mix, for the duration of any prescription. This raises the possibility that prescribers may need to consider alerting the licensing authority to suspend the drivers license if it cannot be verified that a prescription will not impair the user and put the patient and/or public at risk.… Read more »

Lloyd T. Clarke

I have worked as a family and ER doctor in a rural community adjacent to a large First Nation Reservation for 20yrs. The resources available for people who are addicted to narcotics is paltry. The ability of a family doc to help a patient who wants to quit is hampered by distance to resources, and timely access among other things. While the creation of Suboxone clinics has mitigated some of the problems it is only reaching a small part of the problem. I would like to see what is intended to be done on the part of development of resources and… Read more »

locum

I have been a locum in many rural locations and I am often dismayed at how easily opioids are prescribed.  Sometimes a patient has to insist that he does not want opioids.  Furthermore, I have been criticized by rural MDs and nurses for not rushing to give patients opioids.  I really think that opioid guidelines are needed, especially in rural areas, where the prescribing habits of some MDs is a significant problem.

anthony Russell

Chronic pain syndromes are normally centrally mediated problems-if we exclude those few with ,for example,inoperable o/a of the hip.Even there pain “sensitisation” frequently develops.Thus a  psychologic approach, if necessary with psychotropic Rx is required.Frankly it’s not news that opiods dont work.Calling so many of these syndromes “injuries” when there is no evidence of any damage merely adds to the problem.

Noel Hershfield

I saw many patientx with chronic abdominal pain NYD.At least twenty percent had abdominal wall pain,diagnosed by a careful exam in the office.I actually wrote a paper about it.Many of the others I saw had very few significant investigations before being labeled with chronic pain NYD.Before I saw them many consulted chiropractors,massage therapists,and other so called alternative practitioners,some with success.I used all the strategies to treat them.Many were depressed and responded to antidepressants.I attended a meeting in Washington on chronic pain.They used everything to try and control pain,including nerve blocks,psychotherapy,excercise,education about the adverse effects     Of narcotics,before treating with… Read more »

PalliativeMD

I have not seen many proposals to deal with diversion. The Palliative Blue Cross program in AB punishes patients (with more dispensing fees) when opioids are dispensed at shorter intervals, and encourages three month dispensing.  So when the dose or drug or route changes a few weeks later, another three months’ worth are dispensed. Pharmacies in AB are not required to take back the medications, leaving families in possession of very large quantities of opioids, often injectables, which is a risk to them if it becomes known. It is also an unnecessary financial drain on the Palliative Blue Cross program… Read more »

Jeremy Reed

Acetaminophen, NSAIDS, Lyrica/Gabapentin, maybe medical THC, depo-medrol injections, TCA’s, a pain specialist if needed for expert dosing and maybe focal injections of roots/ganglia, possibly physiotherapy, possibly psychiatry and/or psychology, and most importantly – SPEND SOME TIME WITH YOUR PATIENTS.  Find out what NSAIDS they’ve tried and what worked and what didn’t.  Do they take their NSAID with food always??  Are they on a PPI/H2?  Encourage them to get going – get moving.  Get back to life as much as possible.  Reassure them that getting out with their kids and playing catch may hurt a little, but it will not harm.… Read more »

Kristine

I live with Chronic Migraine. On average I have 12 per month. 25-50% of the time I require 2 Percocet to abort my Migraine when my Triptan and NSAID is not effective. I need access to this medication because it will allow me to not have to go to the ER where I am instantly labeled a ‘drug seeker’ or ‘drug abuser’. I will do ANYTHING to avoid the psychological and recently physical abuse I receive at the hands of so called health care professionals. I am very careful with my medication, I only use it when it is necessary.… Read more »

Dr. Karen Mazurek, Deputy Registrar

Thank you for sharing your concern, Kristine. I want to reassure you that nothing the College is doing or recommending will prohibit patients from continuing to receive the prescriptions they currently receive from their physicians. The prescribing guidelines are intended to provide support and education for physicians to help make the best decisions with their patients. To be sure you are getting the best care, my advice is to continue to keep a close relationship with a single prescribing physician and a single pharmacy to be sure your providers understand your medical history.

David Woolliscroft

I refer to your comment on 22 Nov to Kristine. While it is absolutely true the college is not preventing prescribing but please be honest and realistic in your answers. The media, government and the CPSA are putting the blame on physicians. The draft proposal is more enforcement, more harassment, more time and work which will fall to GP’s .Undoubtably we have a duty to do as much as possible to prescribe in a professional manner, in truth so called safe prescribing is a nonsense. Any drug is potentially unsafe that is why we have to prescribe them! Somehow we… Read more »

Dr. Karen Mazurek, Deputy Registrar

David, thank you for commenting. You raise some very good points. I want to be clear that we are not blaming doctors for the opioid crisis. What we are saying is that the medical profession contributed to the problem, we are not responsible for the entire problem. It’s our collective responsibility as a profession and that responsibility includes the College. Yes we need more resources focused on providing more support and less stigma around opioid dependence, and on sharing more options for treating long-term chronic pain. Hosting Alberta’s recent Opioid Prescribing Forum, and this blog, help the College engage decision… Read more »

Barry Ulmer

We appreciated the invitation to participate in this forum, but were disappointed in the overall content. It did not really shed much light on the situation as it relates to people with pain. The content seemed directly related to addiction problems and the illicit drug trade on the street. The charts outlined by the Medical Examiner and Chief Coroner were interesting as they certainly confirmed we have an illicit substance abuse problem, but not one that has been caused by prescribing. The intent of the “College” to promote a standard of care based on the Centers for Disease Control (CDC)… Read more »

Dr. Karen Mazurek, Deputy Registrar

Thank you, Barry, for providing the patient’s voice. I hear your concern, and the patient fear you raise. Let me first say that the College does not and will not limit physicians from prescribing opioids beyond recommended guidelines for legitimate patients with chronic pain. The College heard very clearly from our recent consultation and forum participants that there are legitimate chronic pain patients who need opioids — patients who are benefiting from opioid treatment with improved pain relief and better function, and who are taking their medication responsibly under a physician’s care. As the College works to address irresponsible prescribing… Read more »

Dianne Millette

Thanks to CPSA for inviting Physiotherapy Alberta to be part of the forum.  It was an informative discussion and has given us cause to consider how physiotherapists can further contribute to better management of chronic pain patients.  However, public physiotherapy funding for chronic pain patients is almost non-existent.  There is very limited funding in the proposed provincial standardized model for ambulatory physiotherapy for low-income patients that could apply but many patients must rely upon private pay or extended health benefits.  These funding sources may not be a viable option for many chronic pain patients.  Discussion about publicly funded but privately… Read more »