It is a challenging time to practise medicine in North America, particularly where opioid analgesics and other potentially addictive prescription drugs are concerned. Many physicians in British Columbia have or will encounter prospective patients already using opioids who are seeking primary care.
While treating these patients may be more complex, physicians cannot refuse to accept them, as outlined in the College standard Access to Medical Care. Physicians who choose to conduct a "meet and greet" session can only do so to learn more about a new patient’s health concerns and history, not for the purpose of screening out these patients, which may be seen as discriminatory.
Rather than dismissing prospective patients summarily because they are taking long-term opioids and/or benzodiazepines or z-drugs for chronic pain, they should be told in clear and simple terms at the outset that the College’s standard for prescribing these drugs has evolved based on emerging scientific evidence. Patients should be advised that they will be prescribed medications cautiously, in accordance with the standard, which means that combinations of opioid analgesics (“strong pain medications”) and sedatives (usually “sleeping medications”) are not allowed. Patients who are currently on combinations should have one or the other tapered, starting immediately. The patient may have some input into which is more important to him/her.
Based on this conversation, if a patient is unwilling to accept these terms then the physician may choose not to take the patient into his/her practice.
The College offers two highly-rated educational events to assist physicians in this always-challenging task:
- A limited-enrollment Prescribers’ Course, which makes use of standardized patients to assist physicians with the communications challenge
- A plenary course provided by the Foundation for Medical Excellence of Portland, OR, with the support of the College
View the College’s professional standard: Safe Prescribing of Drugs with Potential for Misuse/Diversion
View questions and answers about the standard: FAQs