Over-use of opioids isan ongoing crisis. Nearly 500 Albertans died from accidental opoid poisoning in the frst nine months of 2017. Three-quarters of those deaths involved ili fentanyl which common laced into other drugs. We have two interrelated problems: over-use of opioids and other rugs, and an ict drug supply tht toxic in a way We've never sean before ver-prescribing of opioid painkillers contribute tothe cris, in part because physicians were told to treat pain more aggressively and that opioids were a safe way to doit. Doctors di’ set out to do harm but we helped ereate the cris, and now we need to help zal Canada hae the second highest Prescription picid use per capita inthe word, and Alberta isthe highest among the provinces \We need to prescribe opioids more appropriately, and that means less. In Alberta we have the most ‘current datain the country, and it showsa remarkable change is happening. n just 12 months from ‘September 2016 to September 2017, the number of Albertans prescribed the fve main opioid painkilers ‘dropped by 7% - that's 3,00 fewer people prescribed opioids in a given manth (mainly codeine). Total volume prescribed dropped 14% (measured in “Oral Morphine Equivalents") ‘Those are big changes, and they're broadly simiar to the latest data from Ontario. Physicians are changing thelr practices n sponse to new evidence ad guidelines, nd guidance from provincial, regulators. ‘The reduction n prescribing is good but it brings risks of ts own. Lowering an opioid-dependent patient's dose too fast or withdrawing the medication altogether rks leaving the patient to turn tlt rugs; we never want to see that happen. We want physicians to prescribe based onthe latest evidence ‘and guidelines, not to stop prescribing opioid altogether, or make sudden changes inte care of Individual patients to meet any numerical target. The welfare of the individual patient comes fist, Any patient or dactor with concerns or questions should contact us directly. Prescribing responsibly also wil reduce the amount of prescribed opoids diverted to the street, which ‘may result in more demand for lic supply. We need to reduce diversion but the transition puts some people at risk ‘We must greatly expand access to treatment for people with opioid use disorder. The number of Patients recehing the two main opioid replacement therapies, methadone and Suboxone, increased ‘more than 20% in the latest 12 months to September 2017, and the numberof physicians presrbing the treatment drugs increased by 33%, Reducing prescribing of opioid painkilers and increasing acess to treatment are important, encouraging ‘trends. They reflect the commitment of individual physicians across the province todo the right thing {or patients, but there is much more to be done. ‘We've removed regulatory bartiers to prescribing Suboxone, allowing more primary care physicians to provide this treatment. We're also working with experts to streamline methadone prescribing and {enable emerging evidence-based treatments for opioid use disorder suchas sustained-elease oral ‘morphine and supervised injectable opold agonist treatment, provided by trained physicians inappropriate settings. These steps are intended to support actions Alberta Hesth and Alberta Health Services haue taken tn expand access to treatment We need to identify people at rik and get them whatever help is appropriate Physicians have the same uty to provide compassionate care to people who use substances ast ever patient; appropriate care Includes harm reduction, eg. overdose prevention and response taining, anc naloxone kis fr patients resenting with an opoid overdose, [Most importanty, we must adress the stigma faced by people who use substances when they need care, We must seck to understand the challenges patients who use substances face when they inter ith our healthcare system. Only when we truly understand our patients can we garner the trust needed to provide safe, effective and compassionate care ir. Seatt MeLeod Registrar, College of Physicians & Surgeons of Alberta vavwepeaca