Forcing doctors to register with B.C.'s prescription database would help ensure patients are not receiving too many of the dangerous opioids behind fatal overdoses, addiction and other serious problems, according to a new report.
Less than a third of British Columbia's physicians are using PharmaNet, the provincial system that records all prescriptions, according to a report released Tuesday by the B.C. Centre for Excellence in HIV/AIDS and endorsed by 73 addictions and public health experts from around the province.
PharmaNet records data such as the drug name, dose, quantity, prescribing doctor and duration for all prescriptions dispensed in B.C.'s pharmacies. All pharmacists can access it and physicians working in B.C.'s methadone clinics or transient-care settings, such as hospital emergency departments or walk-in clinics, must be able to use it. But many other physicians have been reluctant to sign up and pay the $8 monthly fee to access PharmaNet, according to Evan Wood, co-director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS.
That's a huge problem, he said, because more than 70 per cent of the province's doctors may be writing opioid prescriptions without knowing their patient's history with the drugs or whether they are already being prescribed the dangerous form of pain medication from another doctor.
Without access to PharmaNet, doctors may also be unsure whether someone is receiving benzodiazepines, the risky pharmaceutical class of tranquilizers like valium or ativan that are often linked to opioid-related deaths in B.C., Dr. Wood added.
Globally, Canadians are the second-largest per capita consumer of opioids, a family of pain medications that includes oxycodone, hydromorphone, morphine and fentanyl. Deaths tied to the synthetic opioid fentanyl have spiked across the four largest provinces in recent years, with fatal overdoses increasing nearly seven times in B.C. from 13 in 2012 to 90 last year, according to a national network of drug researchers.
Dr. Ailve McNestry, deputy registrar for the College of Physicians and Surgeons of B.C., said her agency's board will likely review and approve new guidelines this January mandating all clinicians use PharmaNet, and it could take up to a year for doctors to make the technological change.
"Most younger physicians, who have no technological challenges, would just say 'Of course [I use PharmaNet],'" Dr. McNestry said. "It's mostly about the hassle factor: so it would be physicians who are more of my generation who would have to read the instruction manual and figure out how to connect with PharmaNet through their electronic medical records.
"We're the only province in Canada, I think, that has access to such an informative database and not using it is not justifiable any more."
The experts' report also called on the college to impose a maximum dose for opioid prescriptions, to cut down on supplying of the black market and abuse of the drugs, and for more investment in addiction care and education.
In 2013, more deaths in British Columbia were linked to opioids other than heroin (about 3.5 deaths per 100,000 people) than to motor vehicle accidents involving alcohol (just over 1 death per 100,000 people), according to Tuesday's report.
Charles Webb, president of the association representing B.C.'s doctors, was unavailable for an interview before press time, but said in an e-mailed statement that his organization supports the use of PharmaNet "to ensure the safe prescription of opioids, particularly for patients unfamiliar to physicians at the point of prescription."
Provincial Health Minister Terry Lake said he was surprised so few doctors reported using the database. He said he was committed to talking with the provincial medical association and college to increase participation in the system – something he said might be inevitable in coming years as all patient records are digitized.
Mr. Lake welcomed the new report, stating the province has made significant progress on the issue, through cracking down on pharmacies dispensing methadone illegally, and investing $3-million last year into new ways of treating substance addiction and Dr. Wood's research at the centre.
"There's a lot of blame going on in terms of prescribing practices, but I remember distinctly in the late '80s, early '90s, people said that physicians weren't treating pain well enough, that people were going without good pain medication because of physicians' fear or antipathy toward using opioids," said Mr. Lake. "What we saw was the pendulum swung and it swung too far, so we're seeing a lot of prescription opioid abuse and dependence.
"Now it's time to bring it back into balance and use opioids appropriately."