In an unprecedented move, the College of Physicians and Surgeons of BC (CPSBC) introduced the professional standards and guidelines Safe Prescribing of Drugs with Potential for Misuse/Diversion as a legally enforceable policy on 1 June 2016.
The standard extends the US Centers for Disease Control and Prevention’s (CDC) Guideline for Prescribing Opioids for Chronic Pain to include stimulants and sedatives.
The CPSBC gave no reasons for rejecting the evidence-based Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain or adopting the CDC guideline as a standard.
The CPSBC did not consult the Pain Medicine Physicians of BC Society (PMPoBC) or Pain BC, the key organizations representing physicians with focused pain practices and the one in five British Columbians living with persistent pain.
The PMPoBC wants to minimize harm from drugs we prescribe. However, we are very concerned that enforcing the standard will diminish quality of life in the majority of patients who do not misuse, divert, or become addicted to opioids, sedative, or stimulants. The CPSBC appears to accept this consequence.
The PMPoBC is very concerned that, given the lack of access to interdisciplinary pain clinics and community-based physical and psychological therapies, some patients will seek illicit drugs to relieve their conditions which will further escalate the current public health emergency. We also hope that physicians do not withdraw from managing persistent pain because of mandated restrictions to their practices.
The PMPoBC has written to the CPSBC seeking clarification of many statements in the standard, including those mandating maximum daily doses of opioid and prohibiting trials of opioids in certain conditions, including many psychiatric disorders. We have offered to help the CPSBC revise their standard. We await their response.
—Owen D Williamson, MBBC, FRSCS, FFPMANZCA
President, Pain Medicine Physicians of BC Society
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