Friday, November 4, 2016

Ontario's Drug Strategy: Stupidity, Hypocrisy, or Spite?

Hope you've had a chance to check out the podcast series, which I promise will be as entertaining as I can make it. This, in contrast, is another post too serious for cartoons.

The government of Ontario, having decided that enough is enough with deaths from opioid overdoses, is finally taking action to put a stop to the crisis. Great, you say. Are they putting together a multi-stakeholder task force, with participation by law enforcement, emergency response, and public health, entrusted with the legal authority to act? No. Efforts are to be coordinated through the office of the Chief Medical Officer of Health, which means Ministry thumbs on everything and likely bureaucratic meddling at every turn.

Is Ontario investing in accurate, up-to-date data gathering, so decision makers can track the problem in real time, rather than months down the road through the Coroner's system? No, but they're going to hope that the magic power of partnerships will bring this real-time data to light.

What action is Ontario taking then, you ask? Siccing its favorite attack dog, the College of Physicians and Surgeons on heretofore unsuspecting doctors that might be over-prescribing. Let's look at what this means, both in theory and reality.

The College will be investigating 86 out of some 30,000 Ontario doctors in its probe. Is it even remotely sensible to think that less than 1% of prescribers are flooding the streets with misused or diverted medications? Wasn't the crisis being linked to illegal, not prescription opioids, like carfentanil and liquid fentanyl?

Moreover, why is this all of a sudden the fault of prescribers? With Canadians drinking alcohol in unhealthy amounts by the millions, and leading the developed world in drunk driving, is the government going to start going after bar owners? Or scale back on its liquor distribution empires?

And then there are the likely outcomes of a College crackdown. I've joked repeatedly about the haplessness of provincial bureaucrats in managing health care, but the College of Physicians is a different beast entirely. Doctors have good reason to fear the College. It's acted as a government enforcer in the past, collecting debts for billing aberrations in Soprano-family fashion, until an MD's suicide finally caused the Ministry to call off the hounds. And we can't forget the College's unchecked authority to strip doctors of their licenses, for such grievous crimes as giving a lover free plastic surgery (which somehow meets the definition of sexual abuse, perhaps because the College is wholly incapable of stopping the real thing).

A child could predict what will come of the College's blitz on opioid prescribers. The government will boast about seeing "bad apples" in the medical profession punished. Consumed by fear for what shreds remain of their professional autonomy, doctors will be petrified of prescribing opioids for anybody not actively dying of cancer. Thousands of law-abiding, compliant chronic pain patients will have their prescriptions summarily stopped in the name of public health. Some will just suffer, some will medicate with alcohol, and some will turn to the streets. One thing is for certain: the deaths will just keep on piling up.

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