Safe prescribing. College replies (1)

The College fully appreciates the difficulty in treating patients with medical conditions or symptomatology for which an effective treatment cannot be found, or for which the patient is unable to pay.

Safe Prescribing of Drugs with Potential for Misuse/Diversion was developed over the past year because the previous document, entitled Prescribing Principles, failed to prevent an increasing toll of prescription drug misuse and overdose deaths in this province. Additionally, clinical guidelines developed by NOUGG in 2010, an initiative sponsored by this and other Canadian medical regulatory authorities, have also apparently not been effective in preventing the increasing reliance of prescribers on long-term opioid treatment for chronic noncancer pain.

There is an excellent summary of the current medical evidence and expert opinion in the US Centers for Disease Control and Prevention’s Guidelines for Prescribing Opioids for Chronic Pain. The conclusion of the experts is that opioid treatment for chronic pain provides small to moderate short-term benefits, uncertain long-term benefits, and potential for serious harm.

While there is limited evidence of the long-term benefits of non-opioid therapies, the risk of harm is clearly far less and thus they should be considered preferred treatments. Nonpharmacologic therapies can include exercise and physical therapies as well as psychological therapy such as cognitive behavioral therapy. Not all of these approaches have to be in the context of multidisciplinary programs, which many patients are unable to afford.

The College’s statutory mandate is public protection, and the purpose of this professional standard is to reduce inappropriate prescribing of certain classes of medications. The College cannot address all of the societal problems that make the treatment of patients with chronic noncancer pain so challenging; however, it can try to reduce the additional harm that is caused by unsafe pharmacotherapy.
—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