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National Observer
14-05-2025
- Health
- National Observer
BC opioid rules were aimed at reducing overdoses. But they cut cancer patients' pain meds
Rule changes designed to reduce opioid overdose deaths in British Columbia in 2016 inadvertently harmed cancer and palliative-care patients by reducing their access to pain killers, a new study has found. The study published this week in the Canadian Medical Association Journal describes the impact of a practice standard issued by the College of Physicians and Surgeons of BC that June, about two months after the province declared a public health emergency over opioid deaths. The rule changes were designed to mitigate prescription drug misuse, including the over-prescribing of opioids among patients with chronic non-cancer related pain. The rules weren't meant for cancer and palliative-care patients, but lead author Dimitra Panagiotoglou said there was a "spillover" effect as doctors applied "aggressive tapering" of the painkillers. "(With) the ongoing messages that physicians were getting at the time — opioids being bad — individuals decided to pull back on their prescribing, but there was this larger population-level effect in doing so," she said. "We focus on these two groups because far and wide, it's considered completely acceptable to prescribe opioids for these groups and the concerns around opioids are very different," she said of cancer and palliative-care patients. There were already downward trends in opioid prescriptions for people with chronic non-cancer pain and those receiving palliative care, Panagiotoglou said, and the study shows that trend continued after the change. But among cancer patients, there was a surprising "nose dive" in access to opioids right after the release of the new standard, said Panagiotoglou, who is an associate professor in the department of epidemiology, biostatistics and occupational health at McGill University. The rules were legally enforceable, and physicians found non-compliant could be disciplined or fined under the Health Professions Act and College of Physicians and Surgeons of BC bylaws. The rules were revised in 2018 to address concerns that they were being misinterpreted. The changes in 2016 set a recommended dose ceiling at 90 morphine milligram equivalents or less per day and used "strong language" around co-prescribing with benzodiazepines given the drug poisoning risk, Panagiotoglou said. Among cancer patients, the study found opioid dispensations were 15 per cent lower per person than expected two years after the implementation of the 2016 rules. Over 30 days, that translates to 4.5 fewer days of supply, it says. For people receiving palliative care, the per-person dosage was 6.1 per cent lower, translating to 1.8 fewer days' supply, the study says, while for patients with chronic non-cancer pain — the target population of the rules — dispensations were 8.2 per cent lower. "Over time, people were seeing a meaningful decline in their doses and in the days supplied," Panagiotoglou said of the period between the implementation of the 2016 practice standard and its revision in 2018. The study did not include opioids dispensed in hospitals or long-term care facilities, rather for prescriptions for people living at home. The study says the changes led doctors to increase "aggressive tapering" of patients' medication. Panagiotoglou said evidence suggests this can lead to pain and increase in overdose risk by pushing people toward illicit opioids. The BC college revised its standard in 2018 in response to concerns that misinterpretation was leading to "more conservative prescribing to all patients," not just those with chronic non-cancer pain, the study says. "When the language relaxed and ceiling thresholds were removed, for example, there's this rebound effect where you see, in fact, the amount being prescribed kind of stabilizes or inflects upwards," Panagiotoglou said. The study concludes that its findings show how practice standards can modify physician behaviour, but also highlight "how misinterpretation can harm patients." Panagiotoglou said the findings underscore the potential for "unintended consequences" of sweeping changes to practice standards. Physicians must be careful prescribing opioids, she said, especially given the underlying context of the toxic drug crisis that has claimed more than 16,000 lives in BC since the health emergency was declared in 2016. But Panagiotoglou said it's important to include a diversity of voices at the decision-making table, such as patient-care advocacy groups. The College of Physicians and Surgeons of BC said in an email it could not comment on the study because it was not directly involved in the research. But it said the 2016 practice standard was informed by the "best available guidance at the time," and it has since been "revised substantially." "In the 2016 practice standard, (the college) was explicit in acknowledging and endorsing the use of aggressive pharmacotherapy in the context of active cancer, palliative, and end-of-life care," it said in the statement. This report by The Canadian Press was first published May 14, 2025.
Hamilton Spectator
12-05-2025
- Health
- Hamilton Spectator
Eby makes pitch to American nurses, saying Trump's loss is B.C.‘s gain
Uncertainty in the United States under the administration of President Donald Trump means opportunities for British Columbia as it seeks to recruit much-needed nurses, Premier David Eby said. Eby made a pitch to American nurses as the provincial government said it had shortened the time for them to register to work in B.C. from months to just a few days. 'In British Columbia, you will be valued. Your principles will be respected, and you will have the opportunity to provide care to people not based on how much they earn, but based on the level of care that they need,' Eby told a news conference Monday. 'You will be part of building healthy communities in the best place on Earth, and you are very welcome here. I say, just briefly, President Trump's loss is British Columbia's gain.' British Columbia is launching a targeted U.S. marketing campaign in June in parts of the country where interest in moving to B.C. is the highest, including Washington and Oregon states and select cities in California. Eby said that since B.C. launched its new process for U.S. nurses in early April, 177 people have applied and 113 have received registrations to practise. American nurses can now apply to the BC College of Nurses and Midwives without first going through a third-party assessment organization. The province says collaboration with counterparts from the United States means the B.C. college can access a database to review the education, exam results, employment and registration history of nurses who apply. Recruiters around Canada have reported increased interest from American doctors considering moving to Canada since Trump's election last year. Dr. Joss Reimer, president of the Canadian Medical Association, said last month that American doctors' growing interest in moving to Canada is linked to their frustration with private insurers, and discontent from obstetricians and family doctors worried about 'political interference' in their practices. Asked whether B.C. would be able to match the salary expectations of American health-care workers, Eby highlighted the lifestyle available in B.C. 'The overall interest that we're seeing from Americans coming to practice in British Columbia is the ability to practice in universal health care system, the ability to match lifestyle that they're looking for in more rural communities, often an outdoor lifestyle,' he said. 'What we're seeing is Americans making that decision about how to balance the life that they want to live and where they want to live with the work that they do and the impact they have in community and for many Americans, the balance is coming up that they want to move to British Columbia.' The province announced in March that it was working with the College of Physicians and Surgeons of BC on a process to enable U.S.-trained doctors who hold certification from the American Board of Medical Specialties to become fully licensed in B.C. without the need for further assessment, examination or training. On Monday, Eby said the government would have more to share about that work at a different announcement. — With files from Michael Tutton This report by The Canadian Press was first published May 12, 2025.
