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Rules set to loosen for issuing narcotics

Increased abuse feared

Tom Blackwell, National Post

Published: Wednesday, July 11, 2007

Foot doctors, midwives and nurses would be able to prescribe morphine, Oxycontin and other powerfully addictive medicine under a proposed federal rule that some analysts fear could inadvertently fuel Canada's growing prescription drug-abuse problem.

Health professionals who stand to benefit from a loosening of the decades-old restrictions on "controlled substances" applauded the move. It should mean better service for patients and less strain on the overworked physicians who must prescribe the medications now, they said.

One drug-abuse expert, though, warns that the monitoring and control of opiates is already inadequate, so allowing additional professionals to approve them would shift more pills into the burgeoning black market.

It probably makes sense to give the three groups such prescribing authority, said Dr. Benedikt Fischer of the Centre for Addictions Research of B.C.

However, with Canada using five times as many opiates per capita as the U.K., we need tighter limits generally on the distribution of narcotics, he said.

Research shows prescription-pill addicts have little trouble acquiring medication through doctor shopping, said the expert on drug-abuse policy.

"With more people having the authority to prescribe, you're actually opening the tap further and therefore you're opening the potential for diversion and misuse further," Dr. Fischer said.

"In the middle of the night, you don't want have to call a physician to get an order for something for after-pain that contains codeine," said Kris Robinson, chairwoman of the Canadian Midwife Regulators Consortium. The new prescribing "just makes the process a little smoother."

Controlled substances are drugs deemed to have a higher-than-normal potential for abuse and addiction, such as opiates like codeine and morphine, and such anti-anxiety medicines as lorazepam. Recent reports suggest that the abuse of such prescription drugs is an expanding problem in Canada, partly because there is no national system to monitor distribution of the medications and there is ample opportunity for them to be diverted onto the streets.

Until now, only medical doctors, veterinarians and dentists have been allowed to prescribe them. The draft regulation, published by Health Canada but not yet implemented, would allow podiatrists - foot doctors with extensive university education - licensed midwives and nurse practitioners to also authorize use of the medicines. They can already prescribe some other drugs.

Provincial governments, which have jurisdiction over regulating health professionals, must still give their stamps of approval, but obtaining federal permission was seen as the main obstacle to change.

Under the new rule, the wider group of professionals would have to prove that they have received specific training and certification in diagnosis, pharmacology and drug security, said Alastair Sinclair, a Health Canada spokesman. "This [change] may be important to a patient's comfort and well-being in situations where immediate treatment with a controlled substance is required," the department says in a preamble to the regulation.

Representatives of doctors' professional groups, medical regulators and one private drug-treatment centre said they saw nothing particularly wrong with the new rule, but said regulators must ensure members of the three professions are properly trained to prescribe the drugs.

Midwives would prescribe opiate-based painkillers only on a short-term basis, not for treating chronic conditions, where the potential for abuse is greatest, Ms. Robinson said.

In the provinces where midwives are regulated - British Columbia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia - they undergo training that brings them up to speed with national standards, or "competencies." A national certification exam will soon be implemented, too.

Podiatrists must undergo four years of university study and two years of clinical work before being licensed to practice. Their training includes as much instruction on pharmacology as doctors receive, said Dr. Mario Turnovic,  president of the Canadian Medical Podiatry Association.

They are allowed to perform some foot surgery similar to what an orthopedic surgeon does, but cannot prescribe narcotic painkillers, so must send patients to their family doctors to get a prescription first, burdening the physicians and adding cost to medicare systems, Dr. Turnovic said.
"It's ridiculous," he said. "We've been lobbying the government a long, long time for this."

Nurse practitioners are registered nurses, who for the most part have university degrees and have undergone some additional post-graduate training. They perform some of the same functions as doctors, especially in remote, under-serviced areas.

 
 

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