Safe prescribing (3)

The Section of Psychiatry is both disappointed with and concerned about the new professional standards and guidelines for Safe Prescribing of Drugs with Potential for Misuse/Diversion put into effect by the College of Physicians and Surgeons of BC on 1 June 2016. We believe that the release of this document reflects a striking failure of due diligence, and a major misstep in the College’s fiduciary duty to guard public safety.

By codifying so many complex clinical decisions as standards instead of guidelines, the College has intruded into the doctor-patient relationship in an unprecedented fashion. Limiting opioid dosing to an absolute, no-exceptions maximum of 90 mg of morphine equivalent per day is one such example. In clinical practice, patients’ requirements, physiologies, conditions, and options/alternatives are often highly divergent. Protection for patients on stable, responsible, enduring, and successful opioid treatment regimens that happen to be in excess of this arbitrary figure—and there are many—is lacking in this document.

That the College does not explicitly make an exception for active cancer, palliative, and end-of-life patients is an unconscionable oversight that requires formal revision immediately.

Our biggest concern is the College’s failure to account for the welfare of the many British Columbians suffering from chronic mental illness. The idea that someone who needs a benzodiazepine for treatment of a complex sleep disorder, or a psychostimulant for severe ADHD, now does not have the option of receiving basic ongoing opioid pain control medication if needed—unlike every other patient in the province—is frankly discriminatory. By failing to clearly define “sedatives,” “stimulants,” and “psychoactive medications,” and by painting such treatments with the same brush used for Schedule I drugs, the College further stigmatizes the mentally ill.

The Section of Psychiatry is extremely supportive of well-considered and effective strategies and initiatives that aim to reduce the risk of harm to the public. This document, clearly produced without meaningful input from psychiatrists, will leave physicians in certain cases facing the dilemma of either disregarding standards published by their regulatory body, or compromising patient care. We object.
—Steve Wiseman, MD
Chair, Economics Committee, BC Psychiatric Association
—Carol-Ann Saari, MD
President, BC Psychiatric Association