Opioid prescribing standards changed practices in British Columbia, but with caveats

In an effort to curb misuse of opioids and forestall overdose deaths, the School of Physicians and Surgeons of British Columbia launched a legally enforceable apply normal, “Secure Prescribing of Medication with Potential for Misuse/Diversion,” in 2016. This doc restricted the prescribing of opioids for power noncancer ache (CNCP) with particular prescribing practices that clinicians had been obligated to comply with.

In analysis that examined the consequences of the 2016 apply normal on prescribing to sufferers with CNCP, researchers discovered that its introduction had a marked influence on prescribing practices.

The findings have been revealed within the Canadian Medical Affiliation Journal.

Pre-existing declining tendencies in doses of opioids (measured in morphine milligram equivalents) accelerated, as did declines in high-dose prescribing, coprescribing with hypnotics like benzodiazepines, and prescribing bigger provides of medicines. As nicely, the variety of sufferers who had doses aggressively tapered elevated, which may end up in improper ache administration.

The evaluation included information on all opioid prescriptions allotted to community-living adults in BC between October 2012 and March 2020.

“This demonstrates the power of apply requirements to switch doctor conduct but additionally highlights how misinterpretation can hurt sufferers,” writes Dr. Dimitra Panagiotoglou, affiliate professor at McGill College, Montréal, Quebec, with co-authors. “Affected person teams and physicians affected by requirements or pointers needs to be consulted earlier than their launch to cut back unintended penalties.”

When the 2016 apply normal was changed in 2018, the downward tendencies slowed.

“These findings display that prescribing pointers and apply requirements can have rapid and long-lasting results on doctor prescribing. Though a lot of the modifications could also be optimistic (e.g., fewer opioids in the neighborhood, a discount in coprescribed benzodiazepine), incorrect interpretation can improve harms for some sufferers. Aggressive tapering can have downstream penalties, together with individuals resorting to unregulated opioids for ache aid regardless of their dangers,” write the authors.

Individuals dwelling with power ache and opioid use dysfunction (OUD) in Canada are sometimes unable to entry evidence-based remedy, which might scale back the effectiveness of therapies for OUD, in response to a commentary in the identical difficulty.

“Overcoming boundaries—comparable to siloed take care of OUD and power ache, and restricted entry to allied well being providers that may enhance ache administration and OUD outcomes—is important to successfully addressing the wants of sufferers with comorbid OUD and power ache,” writes Dr. Kiran Grant with co-authors, in a associated commentary. Dr. Grant is an emergency drugs resident on the College of British Columbia, Vancouver, BC.

They counsel interdisciplinary approaches, comparable to together with ache administration specialists in care, may assist enhance outcomes for individuals with power ache and OUD.