Canadian Medical Assocation

We asked e-Panel members about their experiences prescribing opioids. The survey results offer insight into the numerous challenges physicians face and the potential solutions to those challenges.

Completed:
March 2014

Distributed to:
2,813 e-Panel members

Responses:
659

Response rate:
23.0%

Want to share your perspective? Visit the CMA Member Voice e-Panel page for more information on  how to participate in future surveys.

I think we do the best we can. Sometimes physicians have very limited options. I don’t think physicians willingly throw these meds at people in hopes that they will go selling it or abusing it. I don’t think drawing public attention to physicians who prescribe large numbers is useful either. Some people have chronic pain and opioids are all that helps.

Member Voice e-Panel respondent

What members said

Prescription regularity and frequency

Opioid prescription is common, with 83% of respondents prescribing them for pain management (excluding palliative care cases).

While most respondents prescribe opioids for pain management, the frequency of these prescriptions varies:

  • less than once per month (9%)
  • one to three times per month (20%)
  • four to six times per month (21%)
  • seven to nine times per month (11%)
  • 10 or more times per month (40%)

Many respondents are asked for opioid prescriptions by their patients, with half saying they are asked 10 or more times per year.

Challenges

Respondents cited addiction among patients, threatening incidents and difficulties monitoring opioids as challenges related to opioid prescribing. Respondents made many suggestions for the reduction of problematic use.

Inadequate access to mental health services is a substantial contributing problem in many patients I see with pain. Anxiety, depression, inactivity and poor coping skills play a huge part in their pain experience.

-Member Voice e-Panel respondent

There are a number of options on the market for tamper-proof medications such as Targin, OxyNEO and BuTrans patches. Also, less addictive pain relievers such as tramadol, tapentadol and topical analgesics are available to those with private plans. Yet none of these are covered by the Ontario Drug Benefit Program — only the strong, addictive opioids.

-Member Voice e-Panel respondent

Ready access to pain management clinics on referral is a must both for patient welfare and a reasonable alternate management option for the clinician.

- Member Voice e-Panel respondent

Opioids dependence and incidence

Most respondents (92%) have worked with patients who have problematic substance use with opioids, although only 18% often do.

Respondents reported dealing with incidents related to people seeking opioids or other controlled substances. 70% reported minor incidents (such as disrespectful behaviour or verbal aggression); 25% reported major incidents (such as patient throwing or breaking objects); and 11% reported severe incidents (such as assault or attempted assault, and stalking).

The opioid addiction I have dealt with has been in patients accessing opioids on the street. Careful prescribing has prevented abuse of my prescriptions.

-Member Voice e-Panel respondent

Opioid monitoring and guidelines

More than two-thirds of respondents (68%) said their province or territory has a prescription monitoring program, with a fairly equal division between manual and electronic programs. Most are satisfied with the program available to them, with only 8% of respondents rating it as poor.

Awareness of the Canadian guidelines for use of opioids for chronic non-cancer pain was high (73%), with 78% of respondents finding the guidelines somewhat useful or very useful.

78% of respondents are familiar with the opioid prescribing policies and practice standards of the physicians college in their province or territory.

[I] would love to see [an] electronic program that would reduce paper work. [The] concept of monitoring is great and on occasion has identified patients who were accessing opioids from other sources that I was not aware of.

Factors influencing opioid prescription

We asked respondents how significant certain actions would be in contributing to optimal opioid prescribing. Ranked in order of significance:

  • Real-time access to a prescription monitoring program (94% rated as very or somewhat significant)
  • Continuing medical education (89% rated as very or somewhat significant)
  • More specialized pain-treatment facilities in my area (e.g., physician specialists, physiotherapy, psychological counselling) (84% rated as very or somewhat significant)
  • A limit on the number of opioid pills that can be prescribed at any one time (65% rated as very or somewhat significant)
  • More methadone maintenance and other addiction treatment facilities (62% rated as very or somewhat significant)
  • A government requirement that only tamper-proof opioid formulations be approved (60% rated as very or somewhat significant)
  • Minister of Health authority to issue notices about a physician’s overprescribing (44% rated as very or somewhat significant)
  • Regular drug take-back days (35% rated as very or somewhat significant)

Respondents were divided on whether physician overprescribing is to blame for the prescription drug abuse problem. However, most respondents (80%) stated that wait times for specialized pain treatment are a big problem in their area, with 43% saying wait times for methadone maintenance or other addiction treatments are an issue.

The lack of integrated pain clinics makes it very difficult to treat pain with nonpharmacological measures. If a pain patient has to wander to numerous sites and disparate providers it becomes difficult for them to use all the tools as a combined regimen.

What’s next

The input from e-Panel members helped inform our policy on the harms associated with opioids and other psychoactive prescription drugs. That policy recommends that Canada implement a comprehensive national strategy to address the harms associated with psychoactive drugs in Canada, whether illegal or prescription-based. The strategy would complement existing strategies to address the harms associated with alcohol and tobacco, two other legal drugs.

Other e-Panel survey summaries

See what CMA members had to say about other health topics: