2018-02-06 from thestar.com

“Alex” came into the ER at 9:45 p.m. He had trouble breathing. His lips were blue. By 12:05 a.m. Alex was dead. He died from an opioid overdose. This is one example of the opioid crisis.

In response, the government closely monitors physicians who prescribe opioids and a new set of opioid guidelines have been produced to help physicians prescribe this medication more safely. In the past, the recommended upper limit of prescribed opioid was 200 mg of morphine equivalence for a new patient. Now the recommended limit is 50 mg and under certain circumstances, no more than 90 mg. However, flying under the radar of the big opioid crisis is another opioid crisis.

Every week I see patients in my pain clinic who have been prescribed opioids for many years and their dose is being lowered, whether they like it or not, to the point that they cannot function. Their doctor tells them the College of Physicians requires them to do this or they will lose their license to practice. Some patients have gone from being active, to doing almost nothing. Some have even become suicidal.

This is the other opioid crisis. But, is it reasonable and necessary?

Do the Canadian guidelines actually tell physicians to lower their patient’s dose of opioid quickly, without their agreement, and regardless of their function in the end? Recommendation nine from the Canadian guideline states: “For patients currently using 90 mg morphine equivalents of opioids per day or more, with persistent problematic pain and/or problematic side-effects we suggest tapering opioids to the lowest possible dose, including discontinuation, rather than no change in opioid therapy.”

What if a patient tries, but they cannot lower their dose because their function deteriorates? The Canadian guidelines also comment about this. “Some patients are likely to experience significant increase in pain or decrease in function that persist more than one month after a small dose reduction; tapering may be paused and potentially abandoned in such patients.”

So, a patient should not be forced to lower their dose.

The guidelines seem clear. Yet, some doctors still “force” their patients to withdraw. Many physicians have mistakenly interpreted the new guideline to mean that if they do not bring patient doses down to below 50-90 mg they will get in trouble with the college. The only problem is these doctors are not acting according to the very college guidelines they are concerned about.

Read more here