Problematic prescribing may trigger a review

The Prescription Review Program (PRP) manages hundreds of files each year as part of the College’s quality assurance activities. As the media and academic community have drawn attention to the severity of the opioid crisis in North America, some registrants have expressed interest in enhancing their understanding of how the College identifies potentially problematic prescribing that might trigger a review.

British Columbia is fortunate to have PharmaNet, a province-wide prescription drug database that allows the College to have a comprehensive view of physicians’ prescribing practices. All cases in the PRP begin with a review of a physician’s PharmaNet profile. During this initial first step, a medical consultant at the College would consider several factors based on the College’s Prescribing Principles:

  • large dispenses, e.g. dispense sizes of more than 200 pills
  • concurrent prescribing of opioids with drugs that have sedative side effects and/or hypnotics
  • illogical prescribing of multiple drugs with psychotropic effects
  • concurrent prescribing of multiple opioids
  • single or multiple prescriptions that indicate high morphine equivalent daily doses
  • injectable opioids (when prescribed for chronic, non-cancer pain)
  • out-of-date drugs such as meperidine and butalbital

Given the varied nature of physicians’ patient populations, practice settings, and other contextual factors, the decision to open a PRP file is always made by a physician and is never based on a single datum. After the initial PharmaNet review, the PRP requests information from the physician to clarify whether the profile reflects circumstances that justify such prescribing (e.g. a number of palliative care patients, in which case the program does not review appropriateness of care except to advise against large, single dispenses of medications) or rather provides an opportunity for learning. In all cases, the PRP is reviewing both the appropriateness of the prescribing to individual patients and also the application of pharamcovigilance principles to protect the public.

For more information about this quality assurance process, contact the Prescription Review Program at 604-733-7758 extension 2629.