November Messenger 2017

Dina Baras CPSA


Opioid prescribing has turned a corner & started to decline

New data from Alberta and Ontario 

Physicians are prescribing opioids in lower doses and to fewer patients, and it could be in response to evidence-based guidelines, better physician education, new prescribing rules and general awareness of opioid-related issues.

“That’s generally the change we want to see, but it’s early days and the data is very high-level,” says Deputy Registrar Dr. Karen Mazurek. “We and other regulators need to monitor closely to make sure the reductions are happening the right way based on current guidelines, and that patients are not put at risk. We need to use opioids less, but the key is to make sure patients and prescribers feel supported in using them appropriately.” 

The Ontario Drug Policy Research Network released a report in August showing total morphine equivalents (MEQ) prescribed per capita of opioid painkillers dropped by 18% from January 2015 to March 2017. Most of the decrease (11%) occurred in the last six months of that 15-month period. The report also showed 23% of long-term opioid patients received a benzodiazepine prescribed concurrently with an opioid.

In Alberta, the latest data shows the same downward trend, and the same concerns about high-risk practices. The 2016 Triplicate Prescription Program Atlas  shows the number of patients receiving an opioid in Alberta held steady between 2013 and 2016, at about 135 per 1000 people. Total prescribing volume dropped slightly over the past two years.

Our goal is appropriate opioid prescribing based on the evidence. We don’t want to eliminate opioid prescribing altogether.Dr. Karen Mazurek CPSA Deputy Registrar

In 2016, the rate was 1467 OME (oral morphine equivalents) per 1000 Albertans, a 4% decrease from 2014. OME or Oral Morphine Equivalents is a standard unit to measure opioids of different strengths. The conversion table we use is here.

The Alberta data for April-June 2017 shows the same trend as the recent Ontario report (focusing on codeine, oxycodone, hydromorphone, morphine and fentanyl).

Here are some highlights:

The number of patients with an opioid prescription fell by 5% in the past year. In April, May and June of 2016 there were 132,000 patients per month receiving a prescription for opioids. In the same three months of 2017 that number fell to 125,000 per month. Population is growing at just under 2% a year. Factoring that in, the drop in the number of patients was close to 7%.
Total volume fell 13%. Population growth bumps that number to nearly 15%. There were 194 million OME prescribed per month in the second quarter of 2016. In the same quarter of 2017 that number fell to 168 million OME per month.
The reduction in patients is mostly in codeine and oxycodone. These are the highest-volume drugs where experts recommend using alternatives more, especially for opioid-naïve patients.
There are still too many patients in high-risk situations. They may be receiving multiple opioids or receiving opioids together with benzodiazepines.

Physicians are responding to these issues. The Atlas shows we’re moving in the right direction.

For example, about 1,300 patients in 2016 received 600 OME/day or more, 10% fewer than in 2014. Nearly 10% fewer patients received opioids from five or more prescribers. The new CPSA Standard of Practice on prescribing is helping by requiring members to check the patient’s record in the Pharmacy Information Network or an equivalent source before prescribing an opioid.

The welfare of the patient has to come first. If a physician needs help with a particular situation or patient, they should call us.Dr. Mazurek

Going forward, we need to keep supporting members in helping patients. “We’ll continue to work with Alberta Health, AHS, and others to address the wider opioids issue, including advocating for more access to harm-reduction and treatment for opioid use disorder,” says Dr. Mazurek.

“Our focus now is to ensure we reduce the right way.” Physicians should not abruptly reduce their patient’s opioid medication or stop prescribing opioids because they are worried their regulatory College will step in.

“Our goal is appropriate opioid prescribing based on the evidence. We don’t want to eliminate opioid prescribing altogether. We are very aware of the risk of opioid-dependent patients turning to illegal drugs to replace their prescription if their dose is reduced too fast,” adds Dr. Mazurek. “The welfare of the patient has to come first. If a physician needs help with a particular situation or patient, they should call us.”

Treatment suggestions:

  • Use opioid alternatives if possible
  • If opioids are appropriate for acute pain, give the minimum dose for just a few days. Manage the patient carefully if you extend beyond those first few days. 
  • If starting patients on opioids for chronic non cancer pain, follow the 2017 Canadian Opioid Prescribing Guideline.

Was your first Practice Checkup report helpful? Tell us in a 5-minute survey.

Within the last month, you should have received a customized Practice Checkup Report from the CPSA in the mail.
 
Practice Checkup is a quality improvement tool that gives you a personalized and confidential summary of potential risk factors in your practice. It also includes suggestions on how to reduce those risks (when possible).
 
How can we make future Practice Checkup Reports even better?

Please take 5 minutes to share your thoughts in this brief survey. Survey closes November 27th.
Individual responses are confidential and survey results will only be shared in aggregate format.

Questions about your Practice Checkup Report?


What are your colleagues saying about the CPSA's proposed new rules for medical practice? 

Consultation on Direction & Control of a Medical Practice and Sexual Boundary Violations closes Dec. 1st.

The College is gathering feedback from physicians and others on draft amendments to two important standards of practice. 

Don’t wait until Council approves amendments to the standards to tell us what you think. The standards are the baseline for medical practice in Alberta, so it’s important Council understands all the potential impacts on physicians when considering changes.

Click here to find out what the proposed changes are and send us your comments by survey, web form or email.

Here’s a sample of what we’ve heard so far

I share office space and staff with 2 other psychiatrists, but we do not share patients:  must we designate one of us to represent the office, when we do not function as a clinic?"
”Most of these boundary violations make sense for urban centres, but I wonder if in smaller centres dual relationships are impossible to avoid?”
“…I am concerned about a regulated member having to be responsible for the staff in the clinic.”

What do YOU think?

Questions about the consultation process? Email chantelle.dick@cpsa.ab.ca


Check your email – it’s time to renew your CPSA practice permit!

We sent you an email on Nov. 1 with instructions and links to complete your annual renewal. If you didn’t see it in your inbox, check your junk email folder. Still can’t find it? Email us.

Before Dec. 31, 2017, log in to the physician portal to:

  • Complete your Renewal Information Form (RIF)
  • Complete any Professional Corporation Information Forms (PCIF), if applicable*
  • Pay your fees

*For PCs with multiple shareholders: Only the designated physician will see the PC renewal information. Once completed, the PC permit and receipt will be posted to the practice profile of ALL shareholders.

Are you enrolled in PAP?

The College’s Pre-Authorized Payment (PAP) plan will automatically withdraw your fee payments from your account on Dec. 1, and post receipts by Dec. 11.

To sign up, cancel or update your PAP plan complete this form before 4:15 p.m. Nov. 10. 

If you are enrolled in PAP, don’t forget you still need to submit your Information Form(s) by Dec. 31.

Holiday Office Closure
The College’s office will be closed December 24, 2017 – January 2, 2018.
If you have problems and cannot complete your annual renewal during the closure, please call 780-423-4764 or 1-800-320-8624 and leave your full name and a contact number. We will contact you as soon as possible after we re-open on January 3, 2018. Your practice permit will still be valid, and any waiving of a late fee due to technical difficulties will be discussed and assessed at that time.

National e-prescribe service starts limited rollout

Lethbridge the Alberta test site for PrescribeIT™

A small number of Lethbridge physicians will soon be using a new tool to electronically transmit prescriptions from their existing EMRs to a community pharmacy of the patient’s choice. PrescribeIT™ promises to facilitate prescriber-pharmacy communications, enhance continuity of care and reduce prescribing errors, fraud and abuse.

Canada Health Infoway worked with Health Canada, Alberta Health and other stakeholders to create this government-funded service. Canada-wide use is the ultimate goal, with limited rollouts now underway in Ontario and Alberta.

Here’s what you need to know right now:

The Alberta rollout will continue in 2018.

Lethbridge was chosen for the Alberta limited rollout through a rigorous analysis process. Participating physicians and pharmacies will initially use PrescribeIT™ to create, renew and cancel prescriptions and exchange secure messages. TPP prescriptions are included, but electronic transmission of these prescriptions is acceptable only within the limited rollout. Further rollout is planned for 2018 pending evaluation, with new locations and functionalities to be added later in the year.

PrescribeIT will replace other e-prescribe methods when fully implemented.

Once fully rolled out, PrescribeIT™ will be the only accepted method for electronic prescribing in Alberta – no other electronic signatures will be acceptable. Use of PrescribeIT™ complies with the College’s Prescribing: Administration standard of practice.

It’s a team effort.

The CPSA, Alberta Medical Association, Alberta Health, Alberta College of Pharmacists and Alberta Pharmacists Association are all working with Infoway to implement the rollout.

Details about PrescribeIT™ and the rollout are available at www.PrescribeIT.ca

Questions about prescribing? Ed.Jess@cpsa.ab.ca

*Pharmaceutical Information Network


How can communities have their voices heard? CPSA Regional Tour in Cold Lake and Wainwright November 29

On February 28th, 2017, the College of Physicians & Surgeons of Alberta (CPSA) invited physicians, the public and community leaders in Fort McMurray to take part in a series of meetings called Regional Tour.  “The community was completely engaged and determined to make something happen, we just happened to help them get the right people in one room,” says College Government Relations Advisor, Marian Stuffco. A group of concerned, well organized mothers prepared a thoughtful presentation to the College around lack of good obstetric and pediatric care. Others reported frustration with lack of action by local authorities.

Attracting and keeping doctors is not a Fort McMurray problem alone. Alberta’s isolated and rural communities repeatedly voice concerns about physician recruitment and limited access to specialists when we meet to hear concerns about local health care on Regional Tour.

Eight months after Regional Tour, Fort McMurray is on stream to recruit nine new physicians, both general practitioners and specialists. By the end of 2017, all of them will be actively accepting patients.

The CPSA has been running Regional Tour for five years. In that time, we have learned one thing about improving access to medical care:

“It really comes down to community engagement as a whole”, says Marian. “Communities that build relationships usually better understand and connect with one another. They find it easier to share concerns and then solutions.”  It doesn’t just apply to the general public. When doctors regularly meet with colleagues in their community or nearby, they often come up with creative solutions to their own challenges.

When the CPSA comes to your community on Regional Tour, our ultimate goal is making connections that will help your community overcome roadblocks to good medical care. And while this may not happen overnight, it’s important to keep working with your community. As one of the physicians in Fort McMurray noted, “We should have more meetings like this”.

Where next?

On November 29th, the College is hosting meetings in Wainwright and Cold Lake - see the schedule.

What are your community’s barriers to good medical care and what are some solutions? Share with us in the comments!

Regional Tour, the College’s rural outreach program, was piloted in 2012 with the intention of seeing what’s really going on health care in Alberta. Over the course of 5 years  the CPSA has traveled all over the province, visiting  communities affected by natural disasters, where physicians practise in isolation, where there are abnormal prescribing practices or where political activities offer a unique opportunity for collaboration. For more information, visit cpsa.ca/regionaltour.