Download Pain BC`s Response to New Opioid Prescribing Standards

June 17, 2016
Pain BC’s Response to New Opioid Prescribing Standards
Recently, the College of Physicians and Surgeons of BC announced new opioid prescribing
standards.
Safe Prescribing of Drugs with Potential for Misuse/Diversion directs physicians to have
documented discussions with their patients about the benefits of non-pharmacologic and
non-opioid therapies for the treatment of chronic pain. If a risk-benefit analysis indicates
that opioid therapy is appropriate, then physicians are cautioned to avoid prescribing
opioid pain medication and benzodiazepines concurrently, and to prescribe the lowest
effective dosage with ongoing reassessment of the patient, including routine urine testing.
Source: College of Physicians and Surgeons of British Columbia
Read the complete media release. Read the complete Standards and Guidelines document.
Pain BC supports evidence-informed practice for doctors and adequate pain relief for patients. We
strongly encourage non-pharmacological approaches to pain management, and we recognize the
harms of unsafe prescribing. While we support the College's efforts to curb the unsafe prescribing
of medications, we have several important concerns about the implementation of these
standards. Our concerns include the following:
Lack of publicly-funded alternatives
Many people in pain have little access to non-pharmacological pain management. For example,
there isn’t enough public funding for physical therapy, psychological support, and other pain
management services. Patients who have funding through extended health benefits often can't
find experts who have the knowledge and skills in pain management in their local communities.
Standards are too rigid
Pain management is not a one-size-fits-all solution; some aspects of the standards are too
broadly prescriptive, leaving little room for doctors to use their clinical judgement or to respond
to specific patient needs. Every other regulatory body in North America has adopted guidelines
for prescribing pain medications, not legally enforceable standards – for good reason.
No complex care fee code for chronic pain
Doctors in BC do not have enough time in a standard office visit to do a complete pain
assessment (pain, sleep, mood, function); review all the non-pharmacological and
pharmacologic options for pain management; and properly assess patients for risk of addiction.
BC currently has no complex care fee code for chronic pain; if we did, doctors would be able to
spend the time needed with patients with chronic pain. This fee code—or alternate funding that
recognizes the complexity of managing chronic pain—needs to be in place to ensure doctors can
provide optimal pain care.
Misuse of illegal drugs
While there is a crisis with opioid overdoses in our province, the publicly available data
demonstrate that 50% of those deaths were among people without prescription
opioids. Addiction is a complicated disease and the solutions are not simple; people become
addicted to substances for many different reasons. Punitive prescribing standards will not stop
overdose deaths. Our fear is that the standards will result in patients being denied access
to appropriate options for pain relief and that in turn will drive people to the street-based trade
in pain pills. An unintended consequence may be an increase in overdoses as desperate pain
patients seek medication through illicit sources.
Stigmatizing chronic pain patients
The one in five British Columbians living with pain, and the physicians who treat them, need
workable options that don't further stigmatize chronic pain. Persistent pain and addiction do
coexist in a small minority of people; people living with pain and addiction need timely access to
specialized care for both conditions. Conflating chronic pain with addiction and overdose in a
broader sense further stigmatizes people living with pain. One of the root causes of addiction to
opioids —untreated pain—needs to be addressed in a holistic way.
Pain BC is a willing partner in developing and implementing solutions and would welcome the
opportunity to work with the BC government, the College of Physicians and Surgeons of BC, the
Doctors of BC, and others. We aim to advance workable solutions that reduce the harms of opioids
while ensuring adequate pain relief for approximately one million British Columbians who live with
persistent pain.