Appropriate Opioid Prescribing

Illustration of prescription drugs

Canada is in the midst of a crisis, with escalating overdose deaths in multiple provinces and the second highest rate of opioid prescribing/use per capita in the world. Like all health-care regulators around the globe, we are deeply concerned about the devastating impact on patients and communities.

The College developed an opioid strategy in 2016. The main objectives of that strategy were to facilitate appropriate prescribing, protect patient access to care and reduce risks to patients and the public.  As part of that strategy, 84 investigations were initiated based on data received from the Narcotics Monitoring System. All those investigations are complete and while some significant practice problems were identified, most of these investigations resulted in remediation to support appropriate prescribing. Only two cases were referred to discipline.

In addition to investigations, the College also communicated frequently about opioid-related issues and reported regularly on activities and outcomes. This included stressing that safe prescribing doesn’t mean ‘no prescribing.’ While prescription opioids carry risks even when prescribed appropriately, under the right conditions they are critical for good patient care. 
The College is now shifting the focus of our strategy to ensuring that physicians have the resources and information they need to prescribe appropriately. The four main elements of the new strategy include Guiding, Assessing, Communicating and Responding. The new focus includes:

  • Encouraging physicians to access their own prescribing data
  • Promoting educational resources that will give physicians important education and information about how to prescribe appropriately.
  • Providing physicians with feedback about their prescribing in their assessments

Despite the efforts of governments, organizations and individuals, opioid overdoses are on the rise and there continues to be a need for health-system-wide solutions and collaboration amongst government agencies, health-care educators, regulators, physicians and other health professionals to ensure patient well-being and public safety.

The College strategy commits us to a specific action plan within our area of responsibility of medical regulation and is grounded in our steadfast commitment to improved patient and public safety.

CPSO Opioid Strategy

As we focus on quality improvement, it will continue to be a priority to communicate effectively with the profession and the public. We will also be advocating for;

  • physicians to have real time access to patient medication histories;
  • physicians to have access to comparative prescribing data (e.g., MyPractice reports); and,
  • the establishment of a provincial prescription monitoring program.
 The objectives of our revised opioid strategy are to:
  • Promote safe/appropriate prescribing via assessments and quality improvement
  • Respond to inappropriate opioid prescribing

The College’s Opioid Position Statement outlines the key College activities and elements of our Opioid Strategy which promote appropriate opioid prescribing, and highlights the complementary roles of system partners.

For patients living with chronic non-cancer pain

The CPSO recognizes that well-meaning prescribing for pain resulting from legitimate health conditions has, in some cases, contributed to the opioid problem. Individual doctors and the medical profession as a whole must be part of the solution. The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain urges doctors to take a much more conservative approach to prescribing opioids and recommends trying non-opioid approaches to treatment first, and when opioids are appropriate for pain, smaller amounts should be prescribed.

If you are a patient on or considering opioid therapy, please read our Message to Patients Suffering from Chronic Non-Cancer Pain and our FAQ for useful guidance for patients and their families.

Articles from Dialogue magazineCover of Dialogue magazine featuring opioids

Throughout 2017 and 2018, we published a number of articles on opioids in our quarterly magazine, Dialogue, which is distributed to all licensed physicians in Ontario. Click on the links below to read these articles online.

Volume 14, Issue 3, 2018

Volume 14, Issue 2, 2018

Volume 14, Issue 1, 2018

Volume 13, Issue 4, 2017

Volume 13, Issue 3, 2017

Volume 13, Issue 2, 2017

Volume 13, Issue 1, 2017