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Bottles of the prescription painkiller OxyContin.George Frey/Reuters

Ontario's medical regulator has decided to send just one physician to a formal disciplinary hearing after wrapping up investigations into more than 80 doctors who prescribed extremely high doses of opioids to their patients.

The College of Physicians and Surgeons of Ontario (CPSO) announced on Friday that it has completed all but three of its reviews of the prescribing behaviour of 84 doctors, all of whom were flagged by the province for providing the potency equivalent in opioids of more than 150 Tylenol 3s a day to multiple patients in 2015.

In most cases, the regulator opted for some form of "remediation," rather than harsher penalties.

Steven Bodley, the president of the college, said the self-regulating body took a less-punitive approach because it was concerned that physicians afraid of a black mark on their public records might summarily cut off the opioid supplies of patients addicted to the powerful painkillers rather than gradually weaning them off.

"If [patients] are suddenly denied access, they tend to go to the street and pick up opioids that are even more problematic," said Dr. Bodley, an anesthesiologist who specializes in chronic-pain management at his North Bay practice.

"It's a definite risk to patients to have physicians suddenly drop their opioid supply."

Canada is in the grip of an opioid epidemic that began with the overzealous prescribing of medications such as oxycodone and hydromorphone. The spread of illicit fentanyl across Canada has exacerbated the crisis.

Small amounts of the potent painkiller, which dealers often cut into heroin or cocaine, can cause an overdose.

The number of opioid-related deaths nationally in 2017 is expected to top 4,000 once all the figures are tallied, the federal government says – a significant increase from 2,861 such deaths the year before.

The federal government says that in the first six months of last year, 74 per cent of opioid-related deaths involved fentanyl, up from 53 per cent the year before.

In a bid to curb high-dose opioid prescribing, Ontario's Ministry of Health and Long-Term Care scoured its narcotics monitoring system for doctors who were providing the equivalent of more than 650 milligrams of morphine a day to multiple patients.

The most recent Canadian guidelines on opioid use in patients with chronic, non-cancer pain, published last year, recommend strongly against prescribing more than the equivalent of 90 milligrams of morphine per day.

But even the old version of the guidelines – adopted in 2010 and in place when the ministry reviewed the prescribing data – warned doctors to be careful about prescribing more than the equivalent of 200 milligrams of morphine daily.

Of the 81 cases closed so far, the college took no action in 22, offered advice to doctors in six, and recommended a course of remedial self-study in two.

Three of the doctors are no longer practising. Prescribing restrictions were imposed on three.

Nine were officially cautioned by the CPSO committee that oversees investigations. Of those nine, eight were also ordered to undergo mandatory remediation, such as completing a safer opioid prescribing course and working under the guidance of a clinical supervisor.

One doctor received both a caution and prescribing restrictions. The most common outcome, meted out to 36 doctors, was mandatory remediation on its own.

Benedikt Fischer, a senior scientist at the Centre for Addiction and Mental Health (CAMH) in Toronto, said a remedial approach to curbing opioid prescribing makes sense.

"The harm of overprescribing is already done. You can't make that go away," said Dr. Fischer, an expert on substance abuse. "I think this now sends a pretty clear signal over all that the college and the ministry are looking into overprescribing and if it's ascertained that that's what's happening, that steps are being taken. I think that's the most important message."

The college sent just one case down the formal discipline route, that of Robert Cameron, a Windsor doctor who has twice been disciplined by the medical regulator for unrelated reasons.

A disciplinary hearing for Dr. Cameron is scheduled to begin on March 26.

The CPSO restricted Dr. Cameron's prescribing privileges last July, including banning him from prescribing narcotics and some other drugs pending the outcome of his hearing.

A message to the walk-in clinic where Dr. Cameron works was not returned.

Ontario is establishing an opioid emergency task force to provide advice on how to combat the growing overdose crisis. The province’s health minister says his government has the opportunity to save lives every day.

The Canadian Press

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