While
prescription drug abuse and misuse has been highlighted recently in
media reports, no physician should alter his or her prescribing
practice and deny patients access to appropriate pain relief,
provided he or she is exercising best medical judgment and following
recommended practices.
Physicians are referred to the
Newfoundland Medical
Board Guidelines for the
Use of Controlled Substances for the Treatment of Pain. This
guideline states in part:
“The
principles of quality medical practice dictate that the people of
the Province of Newfoundland and Labrador should have access to
appropriate and effective pain relief. The appropriate application
of up-to-date knowledge and treatment modalities can serve to
improve the quality of life for those patients who suffer from pain
as well as reduce the morbidity and costs associated with untreated
or inappropriately treated pain. The Medical Board encourages
physicians to view effect pain management as a part of quality
medical practice for all patients with pain, acute or chronic, and
it is especially important for patients who experience pain as a
result of terminal illness. All physicians should become
knowledgeable about effective methods of pain treatment as well as
statutory requirements for prescribing controlled substances.”
“Physicians should not fear
disciplinary action from the Medical Board for prescribing,
dispensing, or administering controlled substances, including opiod
analgesics, for a legitimate medical purpose and within the
boundaries of professional practice. The Medical Board considers
prescribing, ordering, administering, or dispensing controlled
substances for pain to be a legitimate medical purpose if based on
accepted scientific knowledge of the treatment of pain or if based
on sound clinical grounds.”
“If a complaint to the Medical
Board should arise over prescribing practices, each case is
evaluated on an individual basis. Strict compliance with the
guidelines is not required if good reason is shown for such
deviation.”
Physicians are encouraged to
review and familiarize themselves with the Guideline. Copies of the
Guideline can be obtained from the Medical Board.
Difficulties encountered when
prescribing and monitoring narcotics can be made easier by the use
of pain scales, narcotic flow sheets and patient contracts of the
type detailed in
Evidence-Based Recommendations for Medical Management of Chronic
Non-Malignant Pain, a reference guide for clinicians
produced by the College of Physicians and Surgeons of Ontario (CPSO).
The reference guide is also a
valuable resource regarding general recommendations for the
management of chronic non-malignant pain and the do’s and don’ts of
prescribing narcotics for chronic non-malignant pain. Specific
chapters are also devoted to the treatment of chronic headache,
migraine headaches, neuropathic pain and musculoskeletal pain.
All physicians are encouraged to
visit the CPSO
website. Copies of the reference guideline can obtained from the
office of the Medical Board.
The Physician and
Psychoactive Drugs, published by the authority of the Minister
of National Health and Welfare in 1982 and revised in 1990 asked a
number of questions of physicians to determine whether they may be
part of the problem.
If you answer yes to any of the
following, you may be part of the problem:
- Do you prescribe on demand?
- Do you accept the diagnosis
made by a patient?
- Do you comply with a drug
selection suggested or requested by a patient?
- Do you prescribe small
quantities “to get them out of your office”?
- Do you prescribe any medication
without first performing all necessary examinations to ensure
the patient is in actual need of such medication?
- Do you prescribe before making
every effort to ensure the patient is not obtaining medication
from other sources while under your care?
- Do you leave blank prescription
pads or supplies of narcotics and other controlled drugs in
places accessible to unauthorized individuals?
- Do you practice in isolation
without maintaining a close professional relationship with
pharmacists and other practitioners in your area to facilitate
early identification of drug abuse problems?
- Do you react in a negative
manner when contacted by a pharmacist to confirm a prescription
or to discuss any other matter related to one of your patients?
- Do you permit your
nurse/receptionist to authorize prescription renewals, or relay
such information to the pharmacist on your behalf?
Patient initiated demands for
specific drugs requires careful assessment, particularly if the
patient is new or unknown to the physician.
Dr.
Robert W. Young is the Registrar of the Newfoundland Medical Board. |
