As the opioid crisis worsens there are actions we can take to enable safer drug stewardship

Systems that enable a more streamlined prescription process allow us to change how we are dispensing controlled medications like opioids.

In 2016, the parliamentary Standing Committee on Health filed its Report and Recommendations on the Opioid Crisis in Canada. In the years since, the national opioid crisis has only become more severe.

In 2021, 21 Canadians a day died due to opioids, a 162 per cent increase from 2016 and a 101 per cent increase from just the year before. Addressing this crisis and implementing long-term solutions is incredibly complex and multifaceted. Different solutions are needed to address different elements that contribute to the crisis.

As prescribers, how do we move forward in a way that allows us to continue prescribing opioids while effectively mitigating the associated risks?

Opioids are one option for pain management and there are many instances in clinical practice where their use is critical, such as in cancer treatment. As physicians, we are constantly weighing the risks and benefits of our treatment plans in order to make the best choice for our patients.

This calculation has become increasingly challenging in the face of the opioid crisis because physicians have been left without a meaningful way to monitor and prevent overuse and addiction. Without this, prescribers can feel that their best option is to stop prescribing them altogether, an attempted correction that leaves some patients in severe untreated pain.

Within the federal government’s formal response to the report from the Standing Committee on Health, “Prescription Monitoring and Electronic Prescribing” was an element of the “Prevention” pillar of the Canadian Drugs and Substances Strategy, announced in early 2017. This included the formal recognition of potential benefits to a pan-Canadian prescription monitoring tool that prevents and identifies opioid and other problematic substance use. To complement and improve the effectiveness of prescription monitoring programs, the implementation of PrescribeIT was included in the recommendations.

When you think through the patient prescription journey, there can be many gaps in contact with their care team and in monitoring. e-Prescribing tools like Canada Health Infoway’s PrescribeIT enable prescribers to transmit prescriptions directly into the pharmacy management system and allow pharmacists to electronically request prescription renewals from the physician.

Not only does this reduce the risk of lost, damaged, or forged prescriptions, but this system also creates a closed loop because both the physician and pharmacist can see when a prescription is filled, where it’s filled and when a refill is requested.

Systems that enable a more streamlined prescription process and improved medication management allow us to change how we are dispensing controlled medications like opioids without a significant burden on the patient, pharmacy or prescriber.

For example, smaller amounts can be dispensed on a daily or weekly basis, thereby increasing the patient’s touchpoints with the pharmacist. This increased contact with a member of the care team allows for more thorough monitoring because we are getting more information on things like the patient’s adherence to the medication and how they’re responding, so it’s being administered in a safer way.

On top of that, PrescribeIT offers the ability for prescribers and pharmacies to send secure clinical communication to each other through the integrated messaging tool. This permits pharmacists and prescribers to quickly align on an appropriate course of action and provide the best and safest medication approach for their patients.

We can’t hesitate in moving forward with widescale implementation of tools that allow for more effective monitoring and communication within the patients circle of care, such as e-prescribing.

This is an important step to allow for safer stewardship of opioids. In the Canadian Drugs and Substances Strategy, the federal government took the step of naming organizations like Canada Health Infoway as the ones to move this forward, but we need to take even more decisive action. This includes not only more education about the value of these tools but, ideally, set timelines and directives from relevant regulatory and governing bodies to address the urgency of this crisis.

Dr. Peter Selby is a senior medical consultant and a clinical scientist at Toronto’s Centre for Addiction and Mental Health and the Giblon professor of Family and Community Medicine and Psychiatry and Public Health at the University of Toronto.

The article can be viewed in the Toronto Star here.