The College appreciates the opportunity to respond to Dr Paul Harris’s letter to the Editorial Board of the BCMJ. We applaud Dr Harris for championing the need to adequately compensate physicians for the time needed to comprehensively assess complex patients who have difficult diagnoses such as chronic pain and/or addiction. We agree that addiction is a diagnosis that is made over time, and is not synonymous with tolerance. The cardinal signs of loss of control, compulsion, and continued use, despite negative consequences, must be present to make a diagnosis of addiction. This clinical diagnosis can often only be made with longitudinal exposure to the patient, and underscores the importance of being highly selective generally, and vigilant to that risk over time, especially when prescribing opioids for chronic conditions.

It is true that many physicians are not trained specifically in addiction medicine and may not know how to respond when confronted with it. For this reason the College has developed a number of workshops on both addiction and pain management, including a specialized course on safe prescribing that utilizes role playing and patient-simulated scenarios to help physicians in this difficult type of practice. Additionally, the College engages medical consultants with experience in treating patients with complex chronic pain and addiction conditions to assist registrants with this complex patient population. Each year the College interacts with over 200 physicians who have been identified as needing additional training and resources to prescribe safely. The College was also an active contributor to the curriculum development process for the Practice Support Program (PSP) Pain Management Module. The College has been highly supportive of practitioners.

Fee guide matters are not within the purview of the regulatory authority. That is entirely the responsibility of Doctors of BC, the advocate for the profession. We encourage Dr Harris to continue his quest to achieve appropriate remuneration for his work, as well as sensible formularies for patients with chronic conditions. Meanwhile, the College will do what it has done for the last 2 decades: use the provincial database (PharmaNet) to identify physicians who may benefit from further training, particularly in the areas of addiction and chronic pain.

More information on the College’s workshops and courses is available in the Professional Development section of the College website at www.cpsbc.ca [12].
—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