Alternatives to opioids encouraged

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This article was published 16/01/2018 (2281 days ago), so information in it may no longer be current.

The College of Physicians and Surgeons of Manitoba is hoping to have new guidelines for prescribing opioids in place by June.

The proposed standards, which were recently opened to public consultation, encourage doctors to prescribe alternative drugs for pain management, to limit dosages when they feel opioids are necessary, and conduct more comprehensive patient assessments — including urine tests — before prescribing or refilling a prescription.

“We know there is a significant number of patients who are managed on opioids for chronic pain when it has been shown that this isn’t the best strategy,” said Dr. Anna Ziomek, registrar for the college.

“They should be the last thing that we turn to rather than the first thing.”

While Manitoba is not the first province to put forward new standards as the country grapples with an opioid crisis, Ziomek said the college’s decision to set standards across multiple patient categories is a first.

There is certainly overlap — they call for comprehensive histories and physical examinations and for doctors to prescribe the lowest effective dose — but specific standards are proposed for when doctors work with patients following surgery as opposed to patients with no history of opioid use or patients currently using prescription opioids or adolescents.

Not only does it make it easier for physicians with a variety of patients to more closely monitor their use of opioids, Ziomek said, but it also makes the risk of opioid use more blatant.

“It enables patients to understand why there has to be more discussion about the use of opioids,” she said. “There’s a requirement for discussion with the patient that has to be documented. Does the patient understand the risks and benefits, have other therapies been tried?”

From an addictions perspective, the Addictions Foundation of Manitoba’s medical director said the proposed standards are welcome.

“We’re happy to see more attention and awareness,” Dr. Ginette Poulin said, especially when it comes to writing the prescription.

“How long, how much, how it’s dispensed, when to get a second option, who to consult can certainly be something that’s helpful,” she said.

“So that we don’t end up in a situation where someone’s on an opioid perhaps inappropriately for an extended period of time.”

The college’s proposal spells out time frames for prescriptions, as well as what should trigger a doctor to consult with a specialist before filling or refilling a prescription.

It’ll be interesting to see what sort of standards actually result from this process, Poulin said, given the college only governs physicians.

Nurse practitioners, who are members of the College of Registered Nurses of Manitoba, can also prescribe opioids, but follow their own standards of practice.

A spokeswoman for the college said despite having a role on the working group that came up with the physician recommendations, it has no plan to adjust its own standards.

For now, Ziomek said the college is hopeful its proposal will garner substantial public feedback.

While the latest figures from the Canadian Institute for Health Information show the quantity of opioids being dispensed in Canada dropped between 2012 and 2016, the number of prescriptions rose steadily. Their use can have profound consequences, resulting in dependence or addiction.

The proposed standards should help people more clearly understand that, Ziomek said.

“They will then understand… how the use of these drugs is really based on a partnership of understanding about risks and benefits and why, sometimes, it’s not a good idea to go down this road.”

jane.gerster@freepress.mb.ca