Re: Opioid prescribing

On behalf of the College, I applaud Dr Alan Ruddiman for his courage and leadership in expressing his personal view on the current opioid crisis in his thoughtful piece, “Opioid prescribing: The profession and the patients we serve and support” [BCMJ 2016;58:439,441].

While virtually all physicians yearn to be better prescribers of opioids and other potentially addictive medications, we have sadly seen far too many cases like “Jack’s,” as described by Dr Ruddiman. Prescribing by some physicians has undoubtedly played a part in the current crisis, and as such, the College echoes his call for physicians to collectively help address it.

One of the most common challenges for physicians, as identified in Dr Ruddiman’s piece, is not knowing what to say to patients who are clearly suffering from pain but who are also vulnerable to potential harms from long-term opioid use. Physicians have an appetite for and are highly receptive to scripts, which they can acquire by calling the College or attending CME activities such as the College Prescribers Course, the Foundation for Medical Excellence Chronic Pain Management Conference (register for both on the College website), or the PSP Chronic Pain Module. Ultimately, patients are owed the information they need to make safe and appropriate choices. That cannot be accomplished without speaking frankly.

Physicians should never forget that they are professionally responsible for the prescription that they provide—both to the patient and public. The standard Safe Prescribing of Drugs with Potential for Misuse/Diversion is written with enough flexibility for physicians to make professional judgments that are in the best interests of individual patients. We thank Dr Ruddiman for his leadership in recognizing that the profession has an obligation to prescribe safely.
—Gerrard A. Vaughan, MD
President
College of Physicians and Surgeons of British Columbia