The development of this or any other professional standard is not “unprecedented.” The College has a statutory obligation to set standards for medical practice, and most elements contained in the standard on safe prescribing have appeared in successive versions developed by the College’s Prescription Review Program entitled Prescribing Principles. The College has been using the prescribing principles in its work with registrants for more than 3 years. Hundreds of BC physicians have successfully operationalized them in their practices—by that measure, they are extensively field tested in real-life clinical settings.
With respect to strong opioids for chronic noncancer pain, successive, authoritative systematic reviews by Furlan, Ballantyne, Chou, and colleagues suggest that, on average, there is weak evidence of modest relief of pain for a period of weeks or a few months, with minimal functional improvement, not superior to naproxen or nortriptyline. Dr Chou’s recent paper in the Annals of Internal Medicine documents accumulating epidemiological evidence of harms, including addiction and death. This is not to say that some patients do not benefit from long-term opioid therapy, only that the benefit is very modest, the risks significant, and the evidence tentative, despite over 20 years of escalating prescribing.
While the College participates in a consultative process during the development of professional standards, it cannot and must not abrogate its legal obligation to regulate medical practice, including prescribing. Regulation is foundational, and the advice in the standard is deliberately formulated in general terms, allowing flexibility for bedside clinical judgment. Nothing in the standard prohibits or even materially interferes with the ability of pain specialists or other physicians to safely and effectively care for their patients.
The College shares concerns that services for patients who suffer from chronic pain are often difficult to access or navigate. Solutions to that are beyond the mandate of the regulator. What is within the College’s mandate is the ability to investigate any report of physicians misapplying the standard to the detriment of patients.
—Gerrard A. Vaughan, MD
President, College of Physicians and Surgeons of British Columbia
—Heidi M. Oetter, MD
Registrar and CEO, College of Physicians and Surgeons of British Columbia
3. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015;162:276-286.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org