Manitoba doctors being monitored for fentanyl prescriptions

The College of Physicians and Surgeons of Manitoba is monitoring who is prescribing fentanyl and how often.

It comes after Winnipeg police and health officials sounded the alarm overthe growingnumber of overdoses and deaths linked to the highly potent painkiller.

• Fentanyl a 'real and present danger' in Manitoba, police and health officials warn
• Fentanyl deaths are a Canada-wide 'disaster'

College registrarDr. Anna Ziomeksaid it's part of the effort toaddress the growing concern about the powerful narcotic, its use byrecreational drug users and the role that doctors may play in that.

"We are looking at prescribers of fentanyl. Who are the top 10 prescribers? We are looking at trends in prescribing, changes over time and if there are questions. Thenthese things can be reviewed. Action can be taken through complaints and investigations around the physician'sprescribing practices," said Ziomek.

But Ziomek saidthere is a distinction between fentanyl prescribed by doctors, which is in a liquid or patch form,and that which is found on the streets. Police said what they are finding on the streetis powder and pill form, but the source of the drug is not always clear.

Organized crime plays a role: police

RCMPassistantcommissioner Kevin Brosseauhashis own theory on how fentanylis winding up on the street.

"It is very clear that organized crime has seized this as being an opportunity to have another drug on the market. Alot of money can be made from trafficking. It is being made in basements and illicit labs,and there are potentially instances where people get their prescriptions pawned off for money. They are being sold in that way. It's an organized drug network," he said.

Ziomeksaidbecause fentanyl is a narcotic, itis prescribed on a special duplicate pad that can be tracked. It has the doctor's name and license number on it.

A physician has to apply to the college to get the pad, andthe pad has 25 numbered prescriptions in it.

One copy goes to the patient, another to the pharmacist.

Physicians can keep track of what narcotics they are prescribing and how often. If the pad is stolen, pharmacies are notified.

Duplicate pads can be audited and monitored. Oxycontinprescriptions are also written using a similarduplicate pad.

College, chief medical examiner working together

Ziomeksaidno physicians in Manitoba are being investigatedfor their prescribing practices of fentanyl, buttheCollege is working closely with the Chief Medical Examiner's Office.

"Whena person has an overdose, the fentanyl shows up in their blood in lethal quantities at the medical examiner's office. But we don't know if that fentanylcame from being sucked out of a patchor if it was injected or taken as a powder," Ziomek said.

She saidall the college can track through the medical examiner's office is prescribed fentanyl.

But she added,"There are deaths that result from overdoses of fentanyl prescriptions. Things that we know that doctors may be contributing to."

"And when there is a death in which a prescription substanceis found, we look at the medical examiner's data about who was prescribing what substances to the patientor what prescriptions were found at the scene, even if they didn't belong to the victim," Ziomek said.

Ziomek saidthe college then writes to the physician to let him or herknow their drugs were involved in the death.

"Or their prescriptions were seen at the death of another person, even if it wasn't their patient. It is an awareness campaign," she added.

The college is also giving its support tothe naloxonestrategy.

TheWinnipeg Regional Health Authority wants to make theoverdose antidote available for free by the end of this year.

Naloxonehelps decrease the effects of opiates includingfentanyl, which can be up to 100 times more potent than morphine, according to Dr. Joss Reimer with the WRHA.

• Winnipeg Naloxone-distribution program could prevent fentanyl deaths

Ziomek saidtighter controls on prescriptions drugs such as fentanyl won't eradicate the problem, though.

"If the stuff they are looking for is no longer available, theyare going to find something else. If we cut out fentanyl,do you really think we are going to cut out the problem? No," said Ziomek.

She saidaddicts will find another drug to take its place.