By Marvin Ross, Guest Columnist
Last week the Chronic Pain Association of Canada issued a press release calling upon the Alberta health minister to investigate the College of Physicians and Surgeons of Alberta (CPSA) for “its unwarranted and secret cautioning and sanctioning” of doctors who prescribe opioid medication.
The press release came after a public meeting of pain patients in Edmonton organized by the group Help Alberta's Pain. Numerous patients showed up to complain about the poor quality of pain care in Alberta.
The meeting was so successful that the organizer, Tracy Fosum, told me that more meetings are being arranged in Edmonton, Calgary, Sherwood Park, Lethbridge and one in Northern Alberta.
An estimated 1.25 million Albertans suffer from chronic pain and 125,000 have long used opiate analgesics in order to function. In March, an Edmonton pain practice shutdown, throwing nearly 1,000 of these patients out of care.
“Thousands of Albertans with pain have lost specialist and primary care because the College of Physicians and Surgeons of Alberta has forced doctors to stop prescribing opiates. The province's pain specialists are retiring in large numbers, citing College intimidation,” Barry Ulmer, Executive Director of the Chronic Pain Association of Canada said in a statement.
In response, the CPSA issued a statement from Registrar Dr. Scott McLeod calling such claims “misinformation” and denying there was an exodus of pain physicians from the profession.
“Many Albertans suffer with severe daily pain and need medical assistance to allow them to live productive lives with their family, friends and in the workplace. We understand the challenges these Albertans face and encourage physicians to work with their patients to find a sustainable solution,” McLeod said. “Responsible prescribing does not include abrupt discontinuation or tapering of opioids or abandoning patients who use opioids.”
McLeod said the CPSA has been successful in reducing overdoses and opioid prescriptions. Accidental overdose deaths in Alberta from prescription opioids have been cut in half, there has been a 20% decline in opioid prescribing since 2016, and 13% fewer patients received an opioid in 2018 compared to 2016.
Patients Denied Treatment
Tracy Fosum recently appeared on the Roy Green syndicated radio show to talk about her personal experiences as a long time chronic pain patient in Alberta. Suffering from what even I recognized as the classic signs of a heart attack, she went to a local Edmonton hospital. Staff were suspicious of Tracy because of her high opioid use and, after a cursory exam, suggested she go home and take some NSAIDs for what they decided were chest muscle spasms.
Later, Tracy went to another hospital emergency room, where she was forced to wait for six hours as, she contends, they mistook her for a drug seeking addict. While trying to convince them to do an EKG, she went into cardiac arrest and collapsed. Fortunately, Tracy survived but ended up with heart damage because she had to wait too long.
Meanwhile, the Ontario College of Physicians and Surgeons is in the process of revising their opioid prescribing guidelines. A new draft policy states: “Physicians must not taper patients inappropriately or arbitrarily. Physicians are reminded that it is not always possible or appropriate to taper below a specific dose, nor is it usually appropriate to suddenly or rapidly taper prescriptions.”
The proposed guideline also states that “arbitrarily refusing to prescribe these drugs in all cases and without consideration for the circumstances of the patient may lead to inadequate patient care.”
While this is a step in the right direction, the problem is that patients have little recourse other than filing a formal complaint if a doctor provides poor treatment. A formal complaint can take months to years to resolve and ruins a doctor/patient relationship.
I am personally familiar with one case where a chronic pain patient was refused care by a doctor unless she agreed not to take any opioid medication. That doctor was sanctioned for refusing a patient on narcotics and refusing to prescribe narcotics, but the sanction was simply “Don't do that. You cannot refuse.” That patient now has no doctor because no one will take her on.
The Colleges can revise their rules and recommendations all they want, but they also need to ensure that doctors adhere to them.
Marvin Ross is a medical writer and publisher in Dundas, Ontario. He is a regular contributor to the Huffington Post.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.