Calgary

Disabled man says Alberta's new opioid prescription standards made doctor drop him

A disabled Calgary man says new provincial opiod prescription rules are making it harder for him to get his pain medication — and he's not the only one who fears the changes might prompt some doctors to drop their patients.

College of Physicians and Surgeons of Alberta changed rules to 'enhance patient safety'

Brent Waddell's physician says he will no longer be authorized to prescribe his pain medication effective June 30, 2017. (Bryan Labby/CBC)

A disabled Calgary man says new provincial opiod prescription rules are making it harder for him to get his pain medication — and he's not the only one who fears the changes might prompt some doctors to drop their patients.

The new standards, introduced by the College of Physicians and Surgeons of Alberta, took effect April 1. The standards require doctors to justify prescribing decisions with documented proof of a patient's initial assessment and ensure opioids are the best continued course of action for patients. 

It's estimated prescription opioids were a contributing cause of death in five per cent of the 343 fentanyl deaths in Alberta in 2016.

The good intentions of the college, however, have backfired for at least one Calgary patient. 

Brent Waddell received a letter from his doctor, Ahmed Abuhelala, stating that effective June 30, 2017, he will no longer have authorization to issue triplicate prescriptions — a procedure that sends one copy of a prescription to the college, one to a pharmacist while one remains with the doctor.

Triplicate prescriptions are mandatory for a host of drugs, including morphine, oxycodone and fentanyl.  

Like getting hit by a baseball bat

Waddell, 49, is considered permanently disabled since back surgery in 2010 left him with debilitating back and leg pain, for which he takes oxycodone up to six times a day. 

An x-ray of the screws in Brent Waddell's spine. (Brent Waddell)

"Without it, it's like someone taking a baseball bat and hitting you right in the lower back," said Waddell. 

He believes the new standard of practice for physicians is the reason his doctor is dropping him, and says another doctor told him the new standard creates more paperwork for physicians with patients requiring opioids. 

In a letter, Dr. Abuhelala told Waddell he would no longer have authorization to issue triplicate prescriptions — although that's not a consequence of the new standards and there are no conditions on his practice permit listed on the college's website. 

  • See the letter at the bottom of this story

Dr. Abuhelala was initially unavailable for comment but contacted CBC News Tuesday morning. He said he was only dropping a few of his patients who rely on prescription opiods. Dr. Abuhelala said it has nothing to do with the college's new standards for prescribing opiods, but did not say what prompted the change, citing patient confidentiality.

In addition to the requirement to justify their prescription decisions, the college also says physicians must:

  • Review the patient's medication history through the Pharmaceutical Information Network and/or Netcare. 
  • Discuss and determine with the patient the best medication choice considering the efficacy of other pharmacological and non-pharmacological treatment options.
  • Evaluate and document risk factors for opioid-related harms. 
  • Re-assess patients on long-term opioid treatment plans every three months. 
  • Document the status of the patient's function and pain at each assessment.
Dr. Ted Jablonski supports the College of Physicians and Surgeons' new standard of practice for prescribing opioids, but fears some patients may turn to illicit drugs if they're abandoned by their doctors. (Bryan Labby/CBC)

Doctors dropping patients a 'dark' possibility, physician agrees

Family physician Ted Jablonski supports the new measures, and says doctors need to be more cautious when prescribing "aggressive" opioid treatments.

However, he says the possibility of doctors dropping their patients, or threatening to, is potentially a "dark side to this story."

He fears those patients may be pushed to look for alternatives on their own.

"If [they] can't get prescription opioids [they] might go on the street and look for illicit drugs," said Jablonski. 

Jablonski doesn't think the college will take it lightly if physicians abandon their patients.

"I would predict this is going to happen and I predict there will be complaints to the college from patients," he said.

College can't comment

The college says it can't comment on whether it has received any patient complaints about doctors dropping or abandoning them since the new standard of practice came into force.

A spokesperson for the college says complaints are confidential.  

Brent Waddell takes oxycodone up to six times a day to relieve the pain in his back and leg. (Bryan Labby/CBC)

"There are appropriate ways where physicians can discharge a patient, but certainly if the patient feels that it is simply because they are on opioids, then that's something we would want to know," said college spokesperson Kelly Eby. 

Waddell says he's already contacted the college about his situation, but has yet to hear back. 

While he says he has enough pain medication to last three months, he's worried about having to find a new doctor.

"It's all up to me and I've got a broken back. I've got to run around and find a doctor," said Waddell. 

View the letter from Dr. Abuhelala below. On mobile? You can read it here

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