Dialogue Volume 13 Issue 3 2017 - Page 28

ply when prescribing any drug, it also includes specific expectations and guidelines for appropriate and effective prescribing of narcotics and other controlled substances, including opioids. The physician’s role is emphasized in preventing and addressing the risk of abuse, diversion, addiction, and overdose that may arise when opioids are prescribed. Furthermore, the policy reflects the release of the 2017 Canadian Guideline, and includes updated guidance and recommendations on key issues, includ- ing: considering alternative treatment options; selecting appropriate doses; monitoring patients for signs of ad- diction; and tapering. While the policy requires physi- cians to be aware of and follow relevant clinical practice guidelines when appropriate, it also emphasizes that decisions with respect to prescribing opioids are always a matter of individual professional judgment made in consultation with patients who are fully informed of the risks and benefits of opioid therapy. Assessments The College assesses physicians in their family medi- cine and other specialty practices to ensure that they are meeting the current standards of practice. Peer assessments have always looked at prescribing practices when applicable, and will include a new emphasis on opioid prescribing. We are also exploring an alternative approach to responding to potentially moderate-risk prescribing by conducting focused assessments. Our goal is to support continued prescribing when it is ap- propriate and informed by both clinical guidelines and College policy. We also conduct regular assessments of physicians who prescribe methadone for the treatment of opioid dependence. Investigations The College will continue to work with the Ministry of Health as necessary to identify levels of opioid prescrib- ing and investigate prescribing practices that may be harmful to patients. The College is aware that while investigations may identify instances of risk of harm to patients when opioid prescribing is continued, there is also a very real risk of harm to patients when opioid prescribing is discontinued. Understanding and ques- tioning prescribing practices is not intended to discour- 28 DIALOGUE ISSUE 3, 2017 age appropriate opioid prescribing and it is imperative physicians do not suddenly cease prescribing to patients currently on opioid therapy. Opioid-use disorder and chronic pain are health con- ditions like any other, and treatments should include all the elements of good practice: making recommen- dations based on evidence and treating patients with respect and compassion. For some, this may include several tactics including a slow taper or opioid replace- ment therapy/referral to a substitute treatment program for methadone or suboxone. Our goal is to support continued prescribing when it is appropriate and informed by both clinical guidelines and College policy. Please see page 9 for an update on the status of opioid investigations announced last November. Facilitating Education The College is collaborating with partners to help en- sure that physicians receive the education, training and resources they need to appropriately prescribe opioids. Our role is to identify and connect physicians with opioid prescribing learning needs to educational resources to improve their prescribing practices. The College supported the development of the University of Toronto’s Safer Opioid Prescribing Program and contin- ues to support updates to the program. Partners’ Roles More than 20 years in the making, Canada’s opioid cri- sis has been propelled by corporate misrepresentation, well-intentioned doctors, and patients with expectations for quick relief. Inconsistent availability of chronic pain centres, addiction services, and alternative therapies to opioid pain relief within the health-care system has only exacerbated the problem. All system partners have a role to play and a respon- sibility to work collaboratively to address a serious public health crisis in Ontario. In addition to ensuring that there are adequate treatment services for chronic pain and addiction, the provincial government is also well positioned to bring the key stakeholders together to ensure that surveillance, education, assessment, and investigations all occur as part of a coordinated prescrip- tion monitoring program in which each player has a