Since the College of Physicians and Surgeons of BC (CPSBC) announced changes to the opioid prescribing standards on June 1 2016, Pain BC and people living with chronic pain, along with representatives from a variety of organizations such as the Pain Medicine Physicians of BC Society, the BC Psychiatric Association, and the People in Pain Network, have been raising concerns with representatives of the College. Read our original official response to the new Standards here. In August, we notified Pain BC supporters that the CPSCBC had issued a Q&A clarifying the new policy. While the Q&A spelled out the intent of the CPSBC, there was no mention of the revisions that had been made to the Standards on August 5; physicians and other stakeholders were notified of those revisions on September 9.
Revisions to the Safe Prescribing of Drugs with Potential for Misuse/Diversion (a section of the CPSBC Professional Standards & Guidelines) document incorporate the following:
- clarification that there is not a limit of 90 MMED for all patients; the standard is intended to direct physicians to assess and document prescribing rather than impose a dose limit for all patients
- a direct acknowledgement that the principles contained in the Standards don’t apply in cases of active cancer, palliative, nursing home, and end-of-life care
- a direct acknowledgement that random urine drug testing and/or random pill counts are appropriate only for adultpatients on long-term opioids, sedatives, or stimulants (and not for children)
- a revision to standard #14 to read "a three-month supply or 250 tablets, whichever is less," rather than a one-month supply
- a direct acknowledgement that it is rarely appropriate to abruptly discontinue long term opioid therapy (LTOT) and that tapering should be done carefully.
Pain BC has discussed the new Standards several times with the College, and the revisions that were made in August provide some evidence that the College is listening. However, despite the revisions, the new Standards have created a situation where patients are being put at risk and in some cases harmed by being denied access to their medication.
While opioid overdoses in BC are undeniably a concern, current media coverage of the fentanyl crisis is fueling a culture of fear around opioids - further stigmatizing and marginalizing people living with pain. Pain BC Executive Director, Maria Hudspith, appeared on the CBC News, Global TV, in newspapers, and on radio stations across the province over the summer to address this issue.
Physicians, people in pain, and family caregivers are fearful. The impact of the new CPSBC Standards on people in pain is very real, and while the revisions may address some of these issues, the pendulum is swinging too far. Policy making doesn’t happen in a vacuum and the Standards can’t be taken in isolation. Pain management is a broader, more complex issue, and the solutions are multi-faceted. These include:
- expanded access to publicly funded interdisciplinary pain services and clinics
- a fee code for physicians to enable them to take the time to properly assess and manage chronic pain
- more clinical and patient education to ensure the latest evidence is directly informing care
- a provincial prescription monitoring program to ensure problematic prescribing is identified and that people in pain and physicians aren’t indiscriminately targeted.
Pain BC is committed to working with our partners to develop and implement tangible solutions to reduce the harms of opioids while making sure the 1 in 5 British Columbians living with pain receive adequate pain relief.
