As It Happens

N.S. physician calls on 'weak doctors' to stop over-prescribing fentanyl

Dr. Douglas Grant, a registrar for Nova Scotia's College of Physicians and Surgeons, blames Canada's opioid epidemic on physicians who are too easily and frequently prescribing pain medication, such as fentanyl, that ends up on the streets.
Fentanyl pills are shown in an undated police handout photo. (Canadian Press)

A leading doctor, who is the registrar of The College of Physicians and Surgeons is calling "weak doctors" to task for their role in supplying the drug, fentanyl, to patients. He's calling for stricter regulations on prescribing the drug amidst a string of opioid-related deaths.

Dr. Douglas Grant was speaking at the Canadian Medical Association's general meeting in Halifax. The meeting focused on opioid use in pain management and how to balance legitimate use with the potential risks of addiction. Dr. Grant emphasized that doctors are partly to blame for the flood of routinely prescribed drugs like fentanyl, oxycodone, and hydromorphone that are increasing available on the streets.

"I think that when we look at the opioid crisis and we look at the various contributors to this rate of prescribing we have in Canada, I think we have to drill down to the underlying psychology," Dr. Grant tells As It Happens guest host Helen Mann.

"Physicians, by their very nature, are fixers, have a desire to help patients and patients have a growing expectation that they will be pain free," he explains.

Dr. Douglas Grant is the registrar of the College of Physicians and Surgeons of Nova Scotia. (John Sherlock)

He argues that the physician's desire to satisfy the needs of the patient have led to an increase in prescribing opioids "that's not connected to evidence based medicine, that's not in line with guidelines and which can be at times, frankly, dangerous."

The registrar is sympathetic to the challenges of treating patients with chronic pain. But he insists there are alternatives that are not being used by the profession.

"There are few tools in the toolbox, or more accurately, many physicians are unaware of the broad variety of non-medicinal approaches available to them or physicians aren't connected to other resources to help." He adds, "any conversation about opioids can't lose sight of the fact that these are an invaluable tool for treating patients with pain."

With limited resources, it is clear that physicians increasingly rely on opioids as an umbrella drug to meet the needs of the patient.

Dr. Grant explains, "I don't think there's any doubt that Canada's the second highest prescribing nation of opioids in the world, trailing only the U.S."

That said, because healthcare is a provincial matter, he also concedes that tracking the data is problematic and that a national registry is unrealistic.

"In a perfect world, each of the provinces would have a robust prescription monitoring program, I can't wrap my brain around how complex it would be to generate a national data bank."
Yesterday, guest host Helen Mann spoke to a longtime fentanyl user from Mississauga, Ontario who sees it somewhat differently.

A Mississauga man says he can't stop using fentanyl because the high makes him indescribably happy. While he understands the risks associated with using fentanyl, he says that he believes that he can use the drug safely. 7:01

The user, whose identity was not revealed to protect his employment and family life, says while he doesn't encourage taking the drugs, opioids can be used safely. He criticized what he called scare tactics, and warnings that are too sensational.

Dr. Grant listened to the As It Happens interview. He concedes,"sure, there are rare high functioning addicts. Sadly, my experience has been that they transition out of this period of high functioning into more dangerous patterns...you're guest yesterday, was I would say, a rare bird."

He adds, "no less an authority than the New England Journal of Medicine declared that we are in an epidemic of opioid deaths, I think we need as a medical profession, as a society, to speak in that plain language."

Dr. Grant says there is no quick fix to the problem. But he feels that physicians must reduce their rates of prescription to address the issue.

"I'm sure there are other routes of supply but we need to be responsible for our bit and again, we need to be responsible for our bit while being sensitive to our patients in pain."

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