Database will allow Ontario to clamp down on over-prescribing doctors

Toby Talbot/The Associated Press

Friday, August 12, 2011 – Globe and Mail


Starting in November, the Ontario government will have the ability to collect information on who’s prescribing how many pills to whom, and where those prescriptions are getting filled.

Regulations attached to the province’s planned prescription database, which has been in the works for months, passed cabinet Wednesday. That means that this fall in theory – and this winter in practice, because that’s when the database will be fully functional – the province can start tracking prescriptions and, eventually, clamp down on what Health Minister Deb Matthews calls an urgent problem with over-prescribed narcotics.

The database will give pharmacists and ministry officials access to information on patient ID, physician ID and dosage for every narcotics scrip written in Ontario. The province is obliged by law to run a public education campaign before it launches the database.

Ministry officials tracking the data will have the power to call the College of Physicians and Surgeons – or, in extreme cases, the police – if they see questionable practices.

“We can begin to do that analysis – identify troubling patterns we can identify the prescribers that are prescribing more than seems to be appropriate and take the appropriate steps.… [Ministry officials] will have authority under law to notify the college of the problem for further investigation. And, in extreme cases, law enforcement,” Ms. Matthews said.

“It’s important that people who need painkillers actually get access to the dugs they need. But at the same time, we know there is a very, very serious problem with over-prescribing.”

What isn’t decided yet is what kind of practices will trigger those red flags. The province says that will be worked out before the database is operational.

Doctors involved in crafting the province’s strategy say this is a good step forward – but only a first step. Physicians, for example, won’t be able to access the database until a later date. And some would like to see more aggressive steps taken, in keeping with a slate of 48 recommendations that came out of an inquest earlier this year into a pair of overdose deaths in Brockville. Those recommendations included a special registry for high-dose, long-term prescription-opioid patients, and eliminating 80-milligram pills, the largest available.

“It’s a start,” said Mel Kahan, an addiction specialist who testified at the Brockville inquest. “But I think it will create some problems for pharmacists and physicians alike.… The physician who writes the scrip won’t know whether the patient is double-doctoring or going to other sources.”

The province’s strategy also includes education for physicians and the public about opioid addictions, which are growing in Ontario. In 2006, there were as many deaths from opioid overdoses as drivers killed in motor-vehicle accidents in the province.

While Canadians use more prescription opioids per capita than almost any other country, Ms. Matthews said, Ontario’s use is the highest in Canada. And prescription opioids are the fastest-growing cause of addiction in the province.

“The statistics speak for themselves,” she said. “And the consequences are absolutely devastating.”

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