Only one doctor may face discipline in Ontario opioid-prescriptions probe

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Only one of the more than 80 Ontario doctors being investigated for prescribing extraordinarily high doses of opioids is facing potential disciplinary action, according to an interim report from a regulatory body that fears harsher punishments could lead to physicians abandoning their opioid-addicted patients.

The College of Physicians and Surgeons of Ontario (CPSO) announced on Friday that it has finished two-thirds of its probes into the prescribing behaviour of 84 doctors, all of whom were flagged by the Ministry of Health and Long-Term Care after a review of the province's narcotics monitoring system.

In the vast majority of its completed investigations, the self-regulator that oversees Ontario doctors opted to focus on "remediation," rather than on disciplining physicians who were found to have prescribed opioid painkillers in amounts equivalent to more than 150 Tylenol 3s a day.

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CPSO president David Rouselle said the college has "major concerns" that the threat of punishment could cause doctors to drastically reduce or cut off supplies of opioids to patients who are physically dependent on the painkillers, prompting the patients to take illegal drugs.

"It's the worst time in history to turn people on to a street supply that's contaminated with fentanyl and other dangerous substances," Dr. Rouselle said. "We really are trying to get the message out to the profession that this is an educational process. We don't want them to be afraid to prescribe appropriately."

The CPSO said that of the 56 investigations completed so far, 33 resulted in sanctions less serious than formal discipline, including requiring a doctor to work under the guidance of a supervisor, undergo more education or stop prescribing narcotics.

Six of those doctors also received a "caution" – a formal warning that appears on a doctor's public record. Three of them are no longer practising.

In 16 of the cases, no action was taken. In four, the doctors were offered informal advice and in two, they agreed to do some "remedial self-study."

The remaining 28 investigations are expected to be completed by the end of this year.

The one high-dose prescriber who is facing a formal disciplinary hearing is Dr. Robert Cameron, a family doctor who works at a walk-in clinic in Windsor.

The CPSO has twice suspended Dr. Cameron's medical licence for unrelated wrongdoing.

In 2013, the college suspended him for three months after police charged him with sexually assaulting a nurse and uttering threats to her about another doctor, who Dr. Cameron said he would like to meet "in a dark alley with a baseball bat."

The criminal charges were withdrawn in 2010 when Dr. Cameron agreed to a one-year peace bond.

In 2011, the college suspended him for one month for failing to "see, assess, treat or respond" to a two-year-old child who was suffering a life-threatening anaphylactic reaction in his clinic.

Messages left for Dr. Cameron at the walk-in clinic Friday were not returned.

Earlier this year, an expert group convened by McMaster University in Hamilton produced new guidelines for opioid use in patients with chronic, non-cancer pain. The group strongly recommended against prescribing more than the equivalent of 90 milligrams of morphine a day to patients.

The 84 doctors flagged for investigations were prescribing the equivalent of more than 650 milligrams of morphine per day to multiple patients.

On Friday, the CPSO's council voted to update its overall drug-prescribing policy to reflect the new Canadian guidelines.

An ongoing Globe and Mail investigation has found that federal and provincial governments across the country did not do enough to forestall the rise of an opioid epidemic rooted in the over-prescribing of powerful painkillers such as oxycodone, hydromorphone and fentanyl.

The crisis has deepened with the arrival in Canada of illicit fentanyl, a synthetic opioid that street dealers are cutting into illegal drugs, primarily heroin and cocaine.

On Thursday, British Columbia announced that fentanyl was detected in 81 per cent of the illicit-drug overdose deaths in that province in the first seven months of this year. British Columbia has recorded 876 suspected illicit-drug overdose deaths so far in 2017, up 82 per cent from the same period last year.

Ontario, meantime, saw 865 opioid-related deaths in 2016, the most recent year for which figures are available. That is a 19-per-cent increase over 2015. Fentanyl was detected in 40 per cent of the 2016 deaths.