The shortage of family doctors in Nova Scotia is highlighting an area of health access that is creating challenges for patients: prescriptions.
“There’s a number of challenges we see with lack of prescriptions,” Dr. Peter MacDougall said, an anesthesiologist in Halifax.
“Patients running out of their medications, patients taking less than maybe they should. All those kinds of things have an impact on their health and it has an impact on the system as a whole.”
Several doctors have retired from communities serving the East Hants region, leaving thousands of patients waiting to be assigned a new family physician through the provincial registry.
As of Jan. 1, more than 46,914 names were on the ‘811 Need a Family Practice Registry’.
Dr. MacDougall recognizes investments are being made into health care to help attract and retain family physicians but he says improvements to the doctor shortages will take time.
“Hopefully, we’ll start to see more physicians coming into Nova Scotia. Also, we’re starting to see other prescribing practitioners, we’re seeing nurse practitioners who are filling in some of the roles,” Dr. MacDougall said.
Health Minister Randy Delorey says a new four-year agreement with Doctors Nova Scotia will address challenges. The new agreement makes doctors the highest paid in the Atlantic provinces and gives more incentives for doctors and specialists to work in N.S.
Glenn Rodrigues is a pharmacist in Elmsdale who is dealing with patients that have lost access to their primary-care doctor.
Rodrigues says there is no “good solution” for people in need of prescriptions to narcotics and controlled drugs.
“I would say if there’s one area where there’s a little more concern, it’s that because a lot of the walk-in clinics, or emergency departments, won’t regularly prescribe narcotics, or controlled drugs.”
In Halifax, pharmacist Peter Jorna isn’t surprised by the lack of access patients may face when seeking prescriptions through walk-in clinics or emergency departments.
“The nature of emergency departments and walk-in clinics is that that’s just not possible because it’s always a new doctor every day, and for that reason, they tend not to want to write prescriptions for those medications,” Jorna said.
Jorna says his pharmacy regularly fills prescriptions for narcotics and controlled drugs like opioids, benzodiazepines and stimulants.
He says the risk of misuse, harm and addiction can be high with those classes of drugs and they aren’t medications people can just stop taking overnight if they lose access to their family doctor.
“If you’re on an opioid for pain, you’re going to go through withdrawal. It would also be the case for benzodiazepines, there’s a risk that you can have seizures that can result in death.”
Monitoring and prescribing methods have changed in recent years to better protect patients from the risks of addiction, misuse and harm.
“Some of the pressures that have been on physicians over the years, have been with changes in guidelines and that all comes because of the issues with patient harm and the opioid crisis and the terrible toll it’s taken on families and neighbourhoods,” Dr. MacDougall said.
Jorna says there is a wide range of risks associated with people who lose access to certain types of drugs, like opioids and benzodiazepines.
“If someone is unable to access their prescriptions through the channel of having a primary-care giver, it may force people to access the illicit market, or the street, to obtain these medications to avoid the withdrawals from it,” Jorna said.
According to Health Canada, more than 9,000 people have died from apparent opioid-related deaths in Canada since 2016.
Dr. MacDougall says new evidence around the effectiveness of opioid prescribing is helping to curb the risks.
“We’ve come to recognize, quite frankly, that some of these medications, particularly the opioid medications, may not be as effective as we had hoped in the long-term. For short-term, they may be very appropriate for pain after surgery, or pain after a significant injury,” he said.