Dr . Rupa Patel

Gaining Control

A Kingston FP took action after realizing that the practice she had just taken over had a large number of patients on high doses of opioids

photo : jonathan sugarman

When Dr . Rupa Patel started work at a Kingston community health centre several years ago , she was in for a surprise – the practice that she had just taken over had a large number of patients on high doses of opioids . Dr . Patel wasn ’ t new to the practice of medicine at the time – she had already worked for 20 years as a family practitioner , with a variety of patient populations in different settings . She had done a three-year stint working in a small town in Northern Ontario , followed by academic family medicine , GP-oncology and family medicine obstetrics . But she remembers that her new practice situation came as a shock . “ I just had not realized that this practice had such a high number of patients on very high doses of opioids . I was simply taking on a new job after having worked in oncology for a few years ,” she explains . She remembers her sense of disbelief as she looked through the practice ’ s medical records . “ There were about 40-50 patients on chronic opioids , some at very high doses … one patient was on 800 mg of oxycontin a day which equals 1200 mg of morphine a day .” Every day of that first year seemed to present a new , uncomfortable experience . “ One patient was very angry when I told her I could not continue to prescribe the opioids that she previously had been on . She had severe COPD and ICU admissions for her breathing problems . I weaned her off opioids but she never forgave me and fired me when she was able to find another doctor . Interestingly , she had no further admissions to hospital after she was weaned but she still fired me . I had only been fired once before in 20 years ,” she said . She realized that a handful of patients were

Issue 1 , 2017 Dialogue 27