Database to help prevent overdose deaths underused
Overdose deaths could be reduced in British Columbia if more doctors used a provincial database to track prescriptions for painkillers, a new report says. The B.C. Centre for Excellence in HIV/AIDS said in its report that opioids such as oxycodone are increasingly being overprescribed to patients who become addicted to the medication. But only 30 percent of B.C. doctors are enrolled in the PharmaNet program, which allows physicians to see if patients are abusing opioids by getting prescriptions elsewhere.
“(That) means that over 70 per cent of B.C. physicians may be writing opioid prescriptions without knowing if the patient in front of them is already prescribed opioids from multiple other practitioners,” the report said.
“This is a very real concern, as evidenced by the case of one B.C. resident who received more than 23,000 pills of oxycodone from more than 50 physicians and 100 pharmacies over five years,” said the report.
“Additionally, practitioners who do not use PharmaNet may be unaware if a patient is receiving medications that pose high risk for overdose if co-prescribed with opioids such as benzodiazopines or methadone.”
From 2005 to 2011, the rate of prescribing strong opioids in the province jumped by almost 50 percent while dispensing of oxycodone went up by 135 percent, said the report.
It said those prescribing rates conflict with increasing research that suggests opioids may have limited long-term effectiveness for treating chronic non-cancer pain.
“In addition to opioid overdose and mortality, there are extensive health and social harms associated with pharmaceutical opioids, including injuries and trauma, increased risk of costly emergency department visits, diversion to street-based markets, drug dealing and other addiction-associated petty crime,” the report said.
Organized crime groups’ manufacturing of counterfeit opioids, often containing fentanyl, fuel the street market for illicit opioids, and that’s “arguably a direct result of long-standing unsafe physician prescribing practices,” the report said.
Pharmacists and doctors in methadone clinics and emergency departments access PharmaNet, but the report said all doctors should be required to use the database when prescribing opioids.
British Columbia’s public health officer Dr. Perry Kendall (pictured) said there are no significant barriers to enrolling in PharmaNet, adding younger physicians are more likely to connect to the database through their electronic medical records compared to older doctors who may not be as tech-savvy.
He said the College of Physicians and Surgeons of B.C. is expected to consider in the new year whether it will be mandatory for doctors who prescribe opioids to be enrolled in the PharmaNet program.
The province has tried other approaches to monitor opioid prescriptions, Kendall said.
“For years B.C. has had a duplicate prescription program so a copy of a prescription for opioids is maintained by the college. And it’s on a special form so it’s difficult to forge.”
Last year, about 25 per cent of fatal overdoses in B.C. resulted from the use of fentanyl, he said, adding the drug has overtaken oxycodone in the illicit market.
The province recently saw a seven-fold increase in deaths from fentanyl use, with 90 people dead in 2014 compared to 13 deaths two years earlier, the report said.
It recommended investment in addiction care and education.
Source: The Canadian Press
Posted December 21, 2015