A lawsuit in British Columbia details how a regulatory body is allegedly “harassing” doctors into taking pain patients off their medications.
The lawsuit stands out against the growing stack of legal claims in Canada and the United States seeking to hold opioid manufacturers, like Purdue Pharma, Sanofi Canada and Pfizer Canada, liable for misleading the public about the potential for addiction to their pain medications.
Those claims pin the blame for what they call the “opioid crisis” on the manufacturers of the drugs, saying their deception led to overprescribing. But the lawsuit filed in February 2023 by Rodney Madryga against the BC College of Physicians and Surgeons is targeting an overreaction to that issue.
And it’s a lawsuit that some advocates say gets at a problem more pressing than overprescribing: how top-down deprescribing harms pain patients and worsens the opioid-involved overdose crisis.
BC resident Rodney Madryga was severely injured in 1997, when the heavy truck he was driving for work “broke through a road and slammed downwards,” according to court documents. Ever since, he has experienced severe chronic pain from a dislocated tailbone, and “quite likely” soft tissue or ligament damage.
A surgery in 1999 only made the pain worse, and doctors determined no further surgery should be pursued. Instead, they settled on pain management “consisting primarily of various opiates,” according to the lawsuit, which said Madryga didn’t respond to other treatments, like non-opioid analgesics.
According to Dr. Mitchell, Madryga’s dosage is “necessary to manage his pain,” and his patient would “experience a very high level of suffering” if he were tapered off.
There is no evidence of Madryga using his medications other than as prescribed, the lawsuit states.
“In my view, there is no significant risk that Mr. Madryga is diverting his medication for sale on the black market,” reads an affidavit from Dr. Ian Mitchell, the physician treating Madryga. “Mr. Madryga’s dosage has remained stable since I became his physician; there have been no early refills, no lost prescriptions or any other warning sign of problematic opiate use. In no sense can Mr. Madryga’s prescription be said to be recreational.”
On the contrary, according to Mitchell, Madryga’s dosage is “necessary to manage his pain,” and his patient would “experience a very high level of suffering that would be unbearable to him and … would be psychologically and physically debilitated by pain” if he were tapered off of his medication.
Despite this, the BC College of Physicians and Surgeons began interfering with Madryga’s treatment in August 2015, “under the guise of a continuing education program,” the lawsuit says—referring to the college’s Prescription Review Program (PRP)—and this effort has continued “unabated since then.”
It started with Madryga’s previous doctor, who, according to the lawsuit, was repeatedly told by the college to reduce Madryga’s dose by 10 percent every two weeks.
The doctor was reportedly “manifestly distressed” by the results of doing so, and pushed back against further pressure to continue reducing the dose, according to the lawsuit. It added that he was “shaken” by the process and asked Madryga to seek out another doctor.
That led Madryga to Mitchell, who faced similar pressure from the college, the lawsuit claims.
The lawsuit claims the college’s de facto position is that no patients should receive a high dose of opioids—and that it leaves “no room” for doctors to disagree with that view.
College standards for prescribing high-dose opioids—defined as a daily dose of over 90 mg of morphine-equivalent—say this can only be permitted “if there is substantive evidence of exceptional need and benefit to the patients,” the lawsuit notes.
“But this exception is nominal and illusory and expressed in bad faith,” it asserts. “In practice, the college does not recognize any exceptions.”
Lawyer Jason Gratl, representing Madryga, described the PRP in a March 2023 interview as “extremely intrusive and unlawful.”
The lawsuit claims the college’s de facto position is that no patients should receive a high dose of opioids—and that it leaves “no room” for doctors to disagree with that view. The lawsuit also questions the science behind the 90 mg limit.
In court filings, Gratl argues the college’s use of the PRP violated Madryga’s rights by interfering in the treatment of his chronic pain and forcing his doctor to taper him off of medications—despite college representatives never having met with Madryga.
The college describes the PRP as purely educational. But Gratl’s court filings call this description “semantically tortured.”
“The ‘learning’ of the physician is manifested not by passing an oral or written test …” the filings read, “but only by changing individual patients’ prescriptions or dropping the patient.”
The program includes self-audits, audits by the college, mandatory training and interviews “that scrutinize the medical files of individual patients,” the filings say, which amounts “in the aggregate to harassment of the physician.”
“The program culminates in disciplinary referrals to the inquiry committee for physicians who refuse this ‘education’ by failing to change their patients’ prescriptions,” Gratl’s filings add.
Through the program, the college allegedly “accesses patient pharmacare records to identify persons with high-dose opiate prescriptions” using BC’s PharmaNet database, “then purports to ‘educate’ the target patients’ physicians by directing their treating physicians to reduce the prescription dosage.”
“The database wasn’t set up to allow the college to spy on patients, to figure out who’s receiving too many opiates.”
Gratl told Filter that this use of PharmaNet is an “abuse and misuse” of the database.
“The database wasn’t set up to allow the college to spy on patients, to figure out who’s receiving too many opiates,” he said. “The college doesn’t have a mandate for oversight of patient care of that type.”
In its own legal filings, the BC College of Physicians and Surgeons says that it “does not proactively access or ‘mine’ pharmacare records on an individualized patient basis,” but rather “reviews physicians’ prescribing practices, without regard to individual patients, and opens a PRP file only if there are several instances of prescribing outside clinical practice guidelines.”
Laying out its own account of how the PRP works, the college insists it doesn’t “harass” doctors.
Rather, it says, the college’s PRP consultants provide “educational feedback tailored to the [doctor’s] unique practice,” and “if the registrant continues to have challenges with safe prescribing, the PRP may make a recommendation to attend a specific course.”
The college says its consultants will interview doctors “to discuss barriers to, and opportunities for, safe prescribing,” and that the consultants may request that a panel review the file “for expert advice.”
That panel then “has the ability to refer cases to the college’s inquiry committee when appropriate.” The inquiry committee has the power to investigate potential infractions of laws or standards, and may refer files to the disciplinary committee.
Court filings for Madryga say that the college’s response does “not deny the allegations … but can be understood as euphemistic restatements of the plaintiff’s statement of facts that are more sympathetic to the college.”
“It’s an emergency, quite frankly, because those people are going to top up from the street supply, which is lethal.”
The PRP fits into a broader pattern of deprescribing opioids, according to Garth Mullins, an organizer with the BC Association of People on Opioid Maintenance (BCAPOM) and a prominent harm reduction activist.
He said deprescribing—not overprescribing—is a key driver of North America’s crisis of drug-related deaths. “It’s an emergency, quite frankly, because those people are going to top up from the street supply, which is lethal.”
“I’m not really one of those people who’s cheerleading the ‘bad doctors, bad companies’ motive,” Mullins told Filter, although “I don’t think Big Pharma is a good idea; I think pharmaceuticals are so important they should be nationalized.”
“I’m sure there was some overprescribing from Purdue and all that,” he continued, “but there was a lot of people that just weren’t getting their pain medication, and the real tragedy came when people were getting cut off those scripts across North America.”
History is now repeating itself, Mullins said, with a renewed prescription-opioid panic over safe supply.
BCAPOM hears from those people “every week,” he added, recalling that this was especially pronounced during the OxyContin panic of the mid-2010s. “We saw loads of people posting up to our meeting, saying they just got cut off their medications.”
History is now repeating itself, Mullins said, with a renewed prescription-opioid panic over safe supply in BC.
“Now that we’re in the middle of the big Dilaudid backlash, safe supply panic from the right, 10 years later, we’re seeing [it] again, sometimes even the same people who are saying they’re getting cut off,” he said.
The court recently heard arguments on an application by the plaintiff to access documents which the college has refused to hand over, claiming it is legally obliged to withhold them. The plaintiff argued the records “deal with how the program was administered on the plaintiff,” and that the law isn’t intended to shield the college from legal action, but to shield doctors—and no doctor is under threat of lawsuit in this case.
The case is scheduled to go to trial in June 2025.
Mullins said he’s sympathetic to people who want to sue the college and the provincial government over deprescribing.
“When they overreact by cutting people off and creating all this death, or invading people’s privacy and making it impossible for pain patients to even access opioids,” he said, “then, yeah, I think it’s smart to try and correct that.”
Photograph by Lucas Guimarães Bueno via Pexels/Public Domain
Show Comments