Opioid expert supports Yukon coroner's recommendations on prescriptions

The chair of a national academic centre on pain management says he agrees with recommendations made by Yukon's chief coroner in the wake of two deaths from mixed drug toxicity. 

In both cases, the patients had obtained large quantities of prescription painkillers, either by refilling prescriptions early or visiting multiple clinics and pharmacies.

Chief Coroner Kirsten Macdonald has recommended setting up a prescription information system where doctors and pharmacists can request up-to-date records of medications prescribed and dispensed to patients. She has also recommended that certain prescriptions be sent directly from doctors to pharmacies and bypass the patient. 

Dr. Norm Buckley, chair of the Department of Anesthesia and director of the Michael G. DeGroote National Pain Centre at McMaster University in Hamilton, Ont., says the problem of opioid abuse and how to monitor prescriptions for the painkillers is a national concern. 

Buckley says doctors sending certain prescriptions directly to pharmacies is already happening in many parts of Canada. 

"At our own pain clinic at McMaster we fax directly to the pharmacy. We no longer give out paper prescriptions for anything," he says. 

Triplicate prescriptions are so named because they are made in three paper copies. One is for the patient, another goes in the doctor's records and another is sent to an overseeing medical body.

Buckley says the idea is a good one but the paperwork often isn't fast enough. 

"The problem as has played out is that it doesn't mean the patient couldn't get several different prescriptions," he said.

"That triplicate in paper from may not be reviewed for quite some time. You don't get quick enough feedback to know this is happening today." 
 
Buckley says a digital system prevents also errors "because it comes off an electronic system, it's also printed clearly, so you avoid the problem of reading physicians' handwriting."

At our own pain clinic at McMaster we fax directly to the pharmacy. We no longer give out paper prescriptions for anything- Dr.Norm Buckley, chair of the Department of Anesthesia at McMaster university

The doctor is blunt when describing the problems with narcotic painkillers.  

"We have two groups. One is the thieves and the people who want to simply deceive you for medication they can resell. The other group (addicts) is in some ways more trouble," he says.

"If somebody actively sets out to deceive us, the likelihood of being successful is pretty good," he says.

One initiative he mentions is that pharmacies in Ontario require photo ID for some prescriptions. Another is a computer network seen in B.C. 

"Some of my colleagues in B.C., when they run their clinic, they have the program open in the corner. When the patient comes in, they can find out all the medications the patient is current receiving — when they were last prescribed and what dose they received," Buckley says.

The Yukon government says it is creating a new electronic health record system for the territory that will include a prescription registry. The new system could be in place within 18 months.