FEATURE Writing Prescriptions Upcoming Dialogue The opioid crisis has taken a disproportionate toll on First Nation Canadians. In an upcoming issue we will look at why so many com- munity leaders have de- clared a state of emergency in their communities. 10 DIALOGUE ISSUE 1, 2019 When responding to requests for narcotics and controlled substances, physicians can implement a number of practical steps to help prevent diversion 1 : Verify the presenting complaint through an assessment. Observe for aberrant drug-related behaviour. creen for current and past alcohol, drugs (prescription and non-pre- S scription) and illicit drug use. o Consider using screening tools from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Look for signs that a patient who legitimately needs opioids may be selling part of their prescription to supplement their income (i.e. asking for a large number of pills). I f the patient is not well known to you, ensure the patient’s identity has been verified. sk the patient if they have received any narcotics or controlled sub- A stances in the last 30 days from another practitioner. Under the federal Controlled Drugs and Substances Act, it is an offence for a patient to fail to disclose this information to a physician. I f available, access the patient’s prescription history. One of the digital health reforms now being implemented in Ontario allows physicians to access the prescription history of patients in real time. Physicians can access the patient’s prescription history of publicly funded drugs, monitored drugs, and publicly funded pharmacy services. Currently, this access to prescription history appears to be more widely available to hospital physicians than to community physicians. imit the number of pills dispensed L wherever possible and clinically appro- priate to do so. 1 We advise physicians consider and apply (as appropriate) the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain in their decision-making. Drug Diversion Program recognizes that physicians may be uncertain about how to proceed when they suspect they have been an unwit- ting pawn in a diversion scheme. He recommends that physicians give him a call for advice at (519) 494-1043 or send him an email at Chris.Auger@opp.ca. “If a physi- cian suspects fraud, then I am happy to talk to him or her about what options are available. I will often point out that while they may think they are the only physician being targeted, in fact, the fraudster likely has a whole network of physi- cians that he or she is defrauding in various ways.” In this article, we describe the precautions you can take to minimize the risk of drug diversion and your obligations should you become aware of illegal activities affecting your prac- tice. We encourage you to read our Prescribing Drugs policy for further information.