Dialogue Volume 12 Issue 3 2016 - Page 14

The College of Physicians and Surgeons of Ontario and the Ontario College of Pharmacists developed a fact sheet about the requirements under the new legislation. Please read at www.cpso.on.ca. another provider, or a concurrent fentanyl prescription from another provider. The prescribing physician is expected to be “reasonably satisfied” that the patient has not already received/is not already receiving fentanyl from another prescriber, based on their discussion with the patient and any other information available to them. Physicians who prescribe fentanyl patches must explain to patients what is required of them under the regulations. This explanation must stress the importance of patients keeping track of every patch, whether used or unused, until it is returned to the pharmacy, because patients who misplace patches will have difficulty obtaining new ones, and because unattended or carelessly stored patches are frequently lost or stolen. Physicians are also expected to make themselves available in a timely and professional manner to pharmacists who call to confirm the validity or other details related to a prescription, or to raise questions or concerns regarding the number of patches returned by a patient (among other potential issues). As is already required by the College’s Prescribing Drugs policy, patient choice must be respected in selecting the pharmacy that is named on each prescription (specifying the pharmacy that will fill the prescription is required under the Act). Earlier, during the consultation on the proposed regulation, the College expressed support for the introduction of a patch-for-patch fentanyl program. In the submission, however, the College was clear that any individual effort to reduce the abuse, misuse, or diversion of a specific drug must be part of a coordinated, system-wide strategy in order to ensure a lasting effect. For this reason, the College believes that the Min- 14 Dialogue Issue 3, 2016 istry of Health and Long-Term Care should evaluate the outcome of the implementation of this legislation. “History has shown that with any drug control mechanism that focuses on a specific drug, limiting access often results in increased demand for other prescription or illicit drugs. The Ministry should establish baseline data and monitor this anticipated consequence of the proposed regulation,” wrote Dr. Rocco Gerace, College Registrar, in the College submission. The College also stated that the Ministry should ensure that physicians who prescribe opioids have more complete and timely access to information about a patient’s opioid medication history prior to prescribing, such as through the provincial Narcotics Monitoring System (NMS). There may also be value in considering new or revised NMS alerts, particularly in order to better inform physicians when a new patient has previously received a fentanyl prescription from another prescriber, wrote Dr. Gerace. Originally developed as an operating room drug, fentanyl is approximately 100 times more potent than morphine and 40 times more potent than heroin. It has been described by The Canadian Guideline for Safe and Effective Use of Opioids as a second line drug for severe pain, and should only be considered if morphine, oxycodone or hydromorphone are not appropriate for the patient. Physicians who prescribe fentanyl patches are advised to review guidelines. The Canadian Guideline for Safe and Effective Use of Opioids is available at http://nationalpaincentre.mcmaster.ca/opioid and the Centers for Disease Control guideline is at https://www.cdc.gov/. Physicians must also ensure that they comply with the requirements of the College’s Prescribing Drugs policy when prescribing fentanyl. MD