Manitoba doctors being monitored for fentanyl prescriptions

The College of Physicians and Surgeons of Manitoba says it is tracking who is prescribing fentanyl as Winnipeg police are sounding alarms over the street drug's use.

Prescriptions for powerful painkiller tracked as Winnipeg police sound alarm over street use

The College of Physicians and Surgeons of Manitoba says it is tracking who is prescribing fentanyl as Winnipeg police are sounding alarms over the street drug's use. (CBC)

The College of Physicians and Surgeons of Manitoba is monitoring who is prescribing fentanyl and how often.

It comes after Winnipeg police and health officials sounded the alarm over the growing number of overdoses and deaths linked to the highly potent painkiller.

College registrar Dr. Anna Ziomek said it's part of the effort to address the growing concern about the powerful narcotic,  its use by recreational drug users and the role that doctors may play in that.

"We are looking at prescribers of fentanyl. Who are the top 10 prescribers? We are looking at trends in prescribing, changes over time and if there are questions. Then these things can be reviewed. Action can be taken through complaints and investigations around the physician's prescribing practices," said Ziomek. 

But Ziomek said there is a distinction between fentanyl prescribed by doctors, which is in a liquid or patch form, and that which is found on the streets. Police said what they are finding on the street is powder and pill form, but the source of the drug is not always clear. 

Organized crime plays a role: police 

RCMP assistant commissioner Kevin Brosseau has his own theory on how fentanyl is winding up on the street.

"It is very clear that organized crime has seized this as being an opportunity to have another drug on the market. A lot of money can be made from trafficking. It is being made in basements and illicit labs, and there are potentially instances where people get their prescriptions pawned off for money. They are being sold in that way. It's an organized drug network," he said. 

Ziomek said because fentanyl is a narcotic, it is prescribed on a special duplicate pad that can be tracked. It has the doctor's name and license number on it.

A physician has to apply to the college to get the pad, and the pad has 25 numbered prescriptions in it. 

One copy goes to the patient, another to the pharmacist.

Physicians can keep track of what narcotics they are prescribing and how often. If the pad is stolen, pharmacies are notified.

Duplicate pads can be audited and monitored. Oxycontin prescriptions are also written using a similar duplicate pad.

College, chief medical examiner working together 

Ziomek said no physicians in Manitoba are being investigated for their prescribing practices of fentanyl, but the College is working closely with the Chief Medical Examiner's Office. 

"When a person has an overdose, the fentanyl shows up in their blood in lethal quantities at the medical examiner's office. But we don't know if that fentanyl came from being sucked out of a patch or if it was injected or taken as a powder," Ziomek said. 

She said all the college can track through the medical examiner's office is prescribed fentanyl. 

But she added,"There are deaths that result from overdoses of fentanyl prescriptions. Things that we know that doctors may be contributing to."

"And when there is a death in which a prescription substance is found, we look at the medical examiner's data — about who was prescribing what substances to the patient or what prescriptions were found at the scene, even if they didn't belong to the victim," Ziomek said.

Ziomek said the college then writes to the physician to let him or her know their drugs were involved in the death.

"Or their prescriptions were seen at the death of another person, even if it wasn't their patient. It is an awareness campaign," she added. 

The college is also giving its support to the naloxone strategy.

The Winnipeg Regional Health Authority wants to make the overdose antidote available for free by the end of this year. 

Naloxone helps decrease the effects of opiates including fentanyl, which can be up to 100 times more potent than morphine, according to Dr. Joss Reimer with the WRHA.

Ziomek said tighter controls on prescriptions drugs such as fentanyl won't eradicate the problem, though. 

"If the stuff they are looking for is no longer available, they are going to find something else. If we cut out fentanyl, do you really think we are going to cut out the problem? No," said Ziomek.

She said addicts will find another drug to take its place. 


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