and other drugs with potential for misuse or diversion
Are you a patient?
- If you are taking a prescribed opioid, check out these safety fact sheets: Opioid Safety for Patients with Acute Pain and Opioid Safety for Patients with Chronic Pain
- Read our Message to Albertans Living With Chronic Pain
- If you are already taking a prescription opioid for chronic pain, you may wish to discuss your treatment with your doctor to make sure your medication and dose are still appropriate. Safely reducing opioid use requires a plan and medical expertise, and should never be done quickly or without a doctor’s help.
- There is some public concern that physicians are abruptly cutting people off their medication. The College has been very clear physicians should not abruptly stop prescribing opioids and must not abandon their patients currently receiving opioids. If this situation applies to you, first speak with your physician. If this does not resolve the situation, you may wish to file a written complaint with the College. File a complaint
A new standard to improve prescribing and enhance patient safety
While opioid prescribing has stopped increasing in Alberta and is starting to come down, there is still much to be done.
In fall 2016, the College consulted widely on a draft standard of practice to improve prescribing safety in general. We received a lot of feedback, from physicians, patients and stakeholder organizations.
Based on the feedback, the draft standard was pared down to focus on just those drugs with potential for misuse or diversion to the illegal drug trade. On March 3, Council considered and approved the new standard of practice, to take effect on April 1, 2017:
These include (but are not limited to) prescription opioids, benzodiazepines, sedatives and stimulants. The new standard puts more checks and balances in place to improve the prescribing of these medications and enhance patient safety.
We ask doctors to be very cautious in starting patients on these drugs in the first place.
Physicians and patients should talk about all the treatment options, understand the very significant risks as well as the benefits of these types of drugs, and decide on a treatment plan together. Physicians are also expected to:
- be able to justify the prescribing decision with a documented assessment of the patient
- check the patient’s medication history from PIN/Netcare or another independent source before writing the prescription
The new standard also includes specific safeguards for long-term opioid treatment for chronic pain (exclusive of active cancer, palliative care and end-of-life care).
The new standard DOES NOT prevent physicians from prescribing opioids when appropriate, or continuing opioid treatment for patients who are dependent.
However, the use of opioids in treating chronic pain must be managed very carefully to minimize patient risk. Patients who take opioids for a longer period of time often develop tolerance and dependence on the drug, so it’s important that they start with the lowest effective dose and are carefully monitored.
- Physicians prescribing opioids to treat chronic pain will need to meet additional requirements to ensure the medication is managed safely and is prescribed only as long as it provides a clinical benefit to the patient. Read the standard
- Physicians must NOT abruptly reduce patients on high levels of opioids and must not abandon their patients currently receiving an opioid prescription. Resources to support safe prescribing are available at cpsa.ca/physician-prescribing-practices
There is more work to be done.
Opioid overuse is a complex issue and requires a multi-layered response. We are working with government, other healthcare organizations, advocacy groups, social agencies and others to find solutions.
The College is also developing an advice document to support physicians in implementing the new standard, as well as other best practices for safe prescribing.
- Advice to the Profession – Prescribing: Drugs with Potential for Misuse or Diversion
- 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain & MAGIC App
- For your patients:
- Physician Prescribing Practices
- Consultation feedback (published September – December 2016)
- Message to Albertans Living With Chronic Pain (December 2016)
- Trevor’s Take (Registar’s messages): November 4, 2016, July 18, 2016
- CPSA Opioid Prescribing Forum (October 2016)