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College of Family Physicians rejects call for mandatory course on safe opioid prescribing

The College of Family Physicians of Canada (CFPC) is rejecting a call by the national association representing medical regulators to make a course on safe opioid prescribing mandatory for family doctors.

The Federation of Medical Regulatory Authorities of Canada made the request to the CFPC as a way to help reduce inappropriate prescribing of powerful opioid painkillers, which are highly addictive and linked to serious side effects and death. Canada is the world's second largest consumer of opioid painkillers, such as oxycodone and hydromorphone, and many addiction experts agree that too many pills are being prescribed.

In a video blog posted to the CFPC website last month, CEO Dr. Francine Lemire said they won't make safe opioid prescribing courses mandatory because they don't want to punish doctors who don't comply.

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"We want to continue to support you in identifying your own learning needs," she said. "We also wanted to avoid penalizing members should they fail to comply with such a requirement."

Lemire noted that doctors who failed to comply would lose their certification in addition to facing possible punitive measures from their provincial regulatory college.

Dr. Gus Grant, president of the federation and registrar of the College of Physicians and Surgeons of Nova Scotia, said he is "disappointed" by the CFPC's decision.

"It's a missed opportunity," he said. "I don't want to be heard to be so naive as to say [education] is the sole solution, but the medical profession has some ownership of this problem."

Doctors are required to take continuing education courses in order to stay licensed. The CFPC offers a variety of different courses, many of which are sponsored by pharmaceutical companies.

Dr. Ed Schollenberg, registrar of the College of Physicians and Surgeons of New Brunswick, said mandatory continuing education on opioid prescribing wouldn't solve the problem, but it would have been a relatively simple way to get more physicians to think about how and when they prescribe those powerful painkilling drugs.

Ada Giudice-Tompson, whose son died after being prescribed Percocet for pain, said the CFPC's refusal to make courses on safe opioid prescribing mandatory is "inexcusable." In most cases, she said, doctors are only told to undergo such courses after being disciplined for inappropriate prescribing that led to patient deaths or other serious outcomes. Canada needs a more proactive approach to stop liberal prescribing of opioids, she said.

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"Why not mandate the prescribing course before this happens? It doesn't make any sense at all to me," she said.

Dr. Jamie Meuser, executive director of continuing professional development at the CFPC, said part of the decision is based on the fact that the organization doesn't have the power to strip a doctor's license to practice if he or she fails to complete a mandatory course on opioid prescribing. Meuser said it would be more appropriate for medical regulatory authorities in each province, which do have that power, to make a continuing education course on safe opioid prescribing mandatory, while the CFPC would be responsible for offering the course.

"Our approach to medication is that family physicians themselves are the best judges of what they need to learn," he said.

But Grant said that by making safe opioid prescribing courses mandatory, the CFPC would have sent a strong message to family doctors.

"I had hoped that this could be a joint initiative," he said. "Making it mandatory would raise awareness across the profession of the extent of this problem."

Grant said his college, along with others across the country, will continue to look at making safe opioid prescribing a mandatory requirement for physicians to remain licensed.

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Meuser said the CFPC understands how serious a problem the opioid epidemic is in Canada and that the college is looking at developing a list of available safe opioid prescribing courses to make it easier for doctors to sign up. He added that "I can pretty much guarantee you that there won't be pharma-funded programs on that list."

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