Sask. does not monitor opioid prescribing practices, dispensing at the province's pharmacies: Auditor's report

Saskatchewan's Ministry of Health does not monitor the dispensing practices the province's 385 pharmacies use when it comes to opioids, according to the latest report from provincial auditor Judy Ferguson.

Ferguson is recommending a new policy be put in place for prescribers to review a patient's medication history before prescribing high-risk medications like opioids.

"For the six most prescribed opioids, Saskatchewan's prescribing stands well above national averages," Ferguson writes in the report.

Regina and Saskatoon had the most hospitalizations related to opioid poisoning per capita in Canada in 2017. The rate of hospitalization for Regina that year was 28.3 per 100,000 people a day while Saskatoon was at 26.1 per 100,000 people. That national average was 16 per 100,000 per day.

Physicians prescribe 95 per cent of opioids in the province.

Between April 1, 2018 and March 31, 2019 — the fiscal year — there were 441,354 opioid prescriptions filled in Saskatchewan. There were another 359,681 prescriptions dispensed to treat addiction, such as methadone. 

Saskatchewan does have a Prescription Review Program designed to identify inappropriate prescribing.

Speaking to reporters Thursday, Ferguson detailed one incident where someone got a prescription for fentanyl one day, followed by methadone from another prescriber on the same day, with another opioid prescription the next day. The person kept cycling through the different prescribers, racking up medications.  

"You can see the time frame very very close. They're obviously not using up the supply of medications that were prescribed," she said, adding that better tools employing data analytics would help to flag such a problem.

During the course of the audit, the ministry had been moving to a better IT system that would employ some of these data analytics, she noted. 

Ferguson pointed out, however, that the province could follow the lead of other jurisdictions in tracking the dispensation of medication, since a gap currently exists in this area. 

Assistant Deputy Minister of Health Mark Wyatt said that the new IT system will enable better tracking of a high volume of information on the prescribing side, even while he acknowledged Ferguson's point that this will not help with the dispensing of medication.

"The idea of developing a dispensing review program is something we're beginning that conversation the College of Pharmacy Professionals as well as the College of Physicians and Surgeons," he said.

Opioid toxicity

Ferguson concluded the ministry also does not know if provincial pharmacies contribute to Saskatchewan's opioid crisis.

There were 119 deaths in Saskatchewan because of opioid toxicity last year.

"Ineffective and insufficient monitoring of opioid prescribing and dispensing practices may result in increased addiction, abuse and misuse, and diversion of prescribed opioids that can ultimately lead to overdoses and death," states the report.