Further discussion on mandatory CPD for opiate prescribing

I want to further discuss the topic of mandatory continuing professional development (CPD) for opioid prescribing, which was addressed by Dr Lemire in the November issue of Canadian Family Physician.¹ If opiate-prescribing CPD became a requirement, then the content and bias of the course becomes extremely important.

California passed a mandate that all physicians who see patients required CPD on pain control. It was sold mainly as a compassionate measure for dying patients who were indeed being inadequately treated, but chronic pain treatment was included and was, in truth, the real target of the CPD. The mandate had been lobbied for by the makers of slow-release opiates and was part of the wider consensus they had purchased that physicians were grossly underusing opiates for chronic pain patients. The mandated CPD produced the desired effect: an explosion in opiate prescribing, with the unintended consequence of an epidemic of deaths from prescription opiates that is ongoing to this day.

Our profession needs to take responsibility for the fact that our prescription pads have been the source, directly or indirectly, of thousands of Canadian deaths in the past 20 years. Our prescribing is the start for many of an opiate addiction that eventually leads to a life of crime, homelessness, or death.

Mandated CPD is a powerful tool, given our profession’s deference to authority. Dr Lemire is right to question if the message of mandated CPD could swing the pendulum the other way. However, given good evidence that chronic opiate use can exacerbate chronic pain, I think the real danger is in a watered-down message that allows physicians to justify their current prescribing habits.

In such a case, mandatory CPD would be less than useless.

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