“People are terrified they are going to lose their medication and be back to a life they had before,” said Barry Ulmer, executive director of the Chronic Pain Association of Canada.
To justify their proposed measures, the college cited statistics suggesting that Alberta doctors were among the highest opioid prescribers in the country, with prescriptions in the province increasing by about 100,000 from 2012 to 2015. Those include thousands of prescribed daily doses equivalent to more than 200 milligrams of morphine; new US guidelines warn against dosages of more than 90 milligrams, the same level that the proposed standard calls on physicians to recommend.
College registrar Dr. Trevor Theman clarified that doctors would not be forbidden from prescribing a daily dose exceeding 90 milligrams, but such a decision must be carefully justified and documented. As for those who have long depended on high doses of opioids, he said they should be treated as diligently as possible. “For some that might mean addictions treatment, for some that might mean being seen in a proper chronic pain setting or using other modalities to treat their pain,” he said.
Provincial officials are in favor of the college’s proposal, as they believe prescription opioids play a substantial, though unmeasured, role in a growing epidemic of overdose deaths from opioids such as fentanyl. “It’s difficult to get a percentage because there are a number of circumstances around those deaths… including prescription drugs, but also illicit drugs and alcohol,” said Alberta’s Chief Medical Officer of Health Dr. Karen Grimsrud. Detective Guy Pilon of the Edmonton police detective has also testified to a substantial uptick in prescription drug abuse in recent years.
Nonetheless, Ulmer is steadfast in his opposition. Most chronic patients who use opioids, he argued, do so as a last resort after experiencing no relief from other medications. He also believes that the proposed regulations will make doctors overly hesitant to prescribe higher doses that are medically necessary, and that the new US guidelines are based on insufficient and unreliable research.
“Pain patients are tired of being lumped in with the addiction population. There are two separate things here and [health leaders] can’t seem to separate them,” he said.
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The College of Physicians and Surgeons of Alberta has proposed regulations aimed at reducing addiction and overdoses from opioids. However, one patient advocacy group says that the rules may unfairly punish pain sufferers who use the drugs, according to a report on the