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College Endorses New Canadian Guideline For Opioid Prescribing

At its May 26 meeting, the Council of the College of Physicians and Surgeons of Nova Scotia endorsed the new 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain as best practices for physicians in Nova Scotia.

“The guidelines reflect the most current scientific evidence available in treating chronic non-cancer pain. The evidence concludes that high doses of opioids over long periods of time pose serious risks to patients including opioid dependency, addiction and overdose,” said Dr. Gus Grant, Registrar and CEO of the College of Physicians and Surgeons of Nova Scotia.

Dr. Grant is one of the authors of the new guidelines released by the National Pain Centre at McMaster University which lays out ten recommendations for physicians prescribing opioids. The authors’ number one recommendation is that opioids should not be the first line of therapy in treating chronic non-cancer pain. The document also advises physicians when starting a patient on opioid therapy, the guidelines recommend dosages less than the equivalent 50 milligrams of morphine per day and no more than 90 mg per day.

The guidelines state that “patients already receiving high-dose opioid therapy should be encouraged to embark on a gradual dose taper, and multidisciplinary support should be offered where available to those who experience challenges.”

“Poor prescribing has been identified as a significant contributor of opioid addiction and overdose. The public and the profession is looking to the regulator to address unsafe prescribing practices”, said Dr. Grant. “The College would expect new prescriptions to be in alignment with the guidelines. However, for those patients already on high doses, care must be taken when attempting to taper these medications. Withdrawal can be dangerous and rapid decrease in daily doses or sudden discontinuation is never acceptable,” said Dr. Grant.

The College is committed to patient safety and recognizes the new Canadian guidelines as an important step in ensuring safe and appropriate use of opioids for chronic non-cancer pain management.

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Methadone Maintenance Treatment (MMT)

Funding responsibility for the Methadone Maintenance Support Program (MMSP) has recently been transferred from the Department of Health and Wellness (DHW) to the Nova Scotia Health Authority (NSHA). The NSHA has indicated to the College that it does not intend to fund the MMSP and will instead direct their resources toward other initiatives. Lacking the necessary funds, the MMSP will close effective immediately.

Physicians prescribing or wishing to prescribe methadone are still required to obtain the College’s endorsement of their Health Canada exemption. Prescribing requirements are outlined in Section 2.1 of the College’s Methadone Maintenance Treatment Handbook.

MMT prescribers must be in good standing with the College and are expected to adhere to the standards and guidelines set out in the College’s Methadone Maintenance Treatment Handbook.

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College Council & AGM Report

The Council also participated in a strategic planning session identifying a strategic focus for the work of the College in the upcoming year. Direction provided by Council will be captured in a strategic plan document for review by the Executive Committee next month. The College aims to be able to distribute the final plan to its members once complete.

At the College’s Annual General Meeting (AGM), the Council recognized the leadership of both Drs. James MacLachlan and Elizabeth Mann upon completion of their terms on Council. Dr. Mann and Dr. MacLachlan both served as presidents of the College and were active members on many Council committees.

The College welcomes the following new members to Council:

The College’s 2016 Annual Report and Financial Statements were also made available at the AGM. Both were sent to members beforehand and are available on the College’s website.

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Gold-Headed Cane Award Winner Dr. Peter Jackson

The College is pleased to announce Dr. Peter Jackson as the recipient of its 2016 Gold-Headed Cane Award .

The award recognizes outstanding community-based physicians who exemplify professionalism in service to their patients, profession and community. The award was presented to Dr. Jackson at the Gold-Headed Cane awards dinner on May 6, 2017.

“Over the course of his career, Dr. Jackson has touched the lives of thousands of Cape Bretoners, working in a largely solo-based practice providing comprehensive family physician care,” said Dr. William Stanish, President of the College of Physicians and Surgeons of Nova Scotia in presenting the award to Dr. Jackson.

Dr. Jackson graduated from Guy’s Hospital Medical School in London, England and immigrated to Canada where in 1965, he began his medical career. Dr. Jackson’s clinical practice included daily hospital rounds, house calls as well as delivering upwards of 100 babies each year.

Dr. Jackson occupied a number of significant leadership roles in the medical community including President of what is now Doctors Nova Scotia, President of the Maritime Medical Care, later known as MSI and Interim Director of the Palliative Care Service in Cape Breton. Dr. Jackson was also an active volunteer member of the Cape Breton Chorale for over four decades.

With over 50 years in medicine, Dr. Jackson retired in 2015 leaving a legacy of medical practice that exudes altruism, service, commitment and compassion for the patients he cared for and for the community in which he lives.

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Guidelines On Responsibilities When Permanently Or Temporarily Closing A Medical Practice

Physicians who permanently close their practice (for reasons such as retirement or relocation), or temporarily close their practice (for reasons such as parental leave or illness expected to last more than three months) are expected to adhere to the Guidelines on Responsibilities when Permanently or Temporarily Closing a Medical Practice.

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Challenges & Opportunities In The Delivery Of Pain & Addiction Care In Rural Communities

September 22, 2017 – Inverness, Cape Breton
Register Online

The Prescribing Course: Safe Opioid Prescribing For Chronic Non-Cancer Pain

October 7, 2017 – Halifax
Register Online

Dalhousie Medical School Launching New Opioid Prescribing Education Programs For Learners And Physicians

The College Lens on Prescribing

This concise document provides an overview of the questions the College may ask when assessing a physician’s opioid prescribing for chronic non-cancer pain management.


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