Helen Jennens flips through two sets of documents 鈥� one for each son who fatally overdosed.
Letters she sent in both cases to the College of Physicians and Surgeons of British Columbia alleging the careless prescribing of potentially dangerous medications are neatly organized among responses from doctors.
Jennens says the deaths of her sons, Rian Leinweber in August 2011 and Tyler Leinweber in January 2016, could have been prevented if doctors had checked their drug histories on B.C.鈥檚 unique real-time database PharmaNet.
The provincewide network links pharmacies and hospitals to a central database that stores information on all dispensed prescriptions. The system is also available to physicians, but doctors say most do not use it.
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Jennens, who lives in 91大黄鸭, has asked the college to make use of PharmaNet mandatory for all doctors so the files of high-risk or drug-seeking patients are flagged.
鈥淏oth boys, I have no idea how they lived as long as they did, with the medications they were prescribed, the combinations they were prescribed,鈥� Jennens says through tears.
Rian was 37 when he died, three years after a truck collided with his motorcycle, crushing his right leg from hip to toe, requiring multiple surgeries.
Jennens went to Rian鈥檚 home with a pot of chili and found him propped up on his bed with his computer on his lap. He鈥檇 stopped breathing from a combined overdose after being prescribed benzodiazepines, various drugs for insomnia and depression, and opioids for chronic pain while he awaited a second hip replacement.
Jennens says she鈥檇 warned doctors Rian could become hooked on opioids because he鈥檇 endured a decade of addiction that included cocaine and crystal meth.
鈥淗e was eight years drug free when he got into that accident. I said, 鈥榃e know legitimately he needs stuff for pain because his leg was shattered but we also have to stay on top of it.鈥� 鈥�
After Rian died, Jennens requested his PharmaNet records and questioned why he was prescribed such a wide range of medications including opioids.
鈥淲hy didn鈥檛 these people say enough? That was my whole issue with PharmaNet,鈥� Jennens says. 鈥滻t lets you know somebody鈥檚 got a drug history. He鈥檚 on this cocktail for three years and nobody is concerned about what may happen in terms of overdose?鈥�
A big part of Jennens鈥檚 complaint with the College of Physicians and Surgeons focuses on mandating the use of PharmaNet, which she says could be optimized to protect patients.
鈥淭hat didn鈥檛 happen, and five years later, my second son died,鈥� she says of Tyler, who had ruptured his left Achilles tendon in 2008 while playing football and was prescribed OxyContin.
He became addicted to heroin and unknowingly took what turned out be fentanyl in his ex-wife鈥檚 bathroom, where he was found dead on the floor. A coroner鈥檚 report says he had overdosed on the powerful opioid.
鈥淗e used to lay in my lap at night and say, 鈥楻emember when I played football? Why can鈥檛 I get that back?鈥� 鈥� Jennens says. 鈥淗is sister saw him twice in the last three years of his life because she wouldn鈥檛 subject her daughter to his behaviour, and it killed him. It鈥檚 killing her now.鈥�
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Armed with 173 pages of PharmaNet records listing Tyler鈥檚 medications, Jennens filed a second complaint and 鈥減leaded鈥� with the college to make the use of PharmaNet compulsory for all doctors.
Jennens鈥� first complaint to the college resulted in one doctor being directed to take two continuing medical education courses on the responsible prescribing of opioids and strategies to manage chronic pain through less reliance on drugs.
Her complaint after Tyler died was forwarded by the college to 20 doctors who were cited for their prescribing habits. In their response letters, some doctors say they did not access PharmaNet, while others say Tyler鈥檚 death prompted them to use it.
Dr. David Hawkins says in his letter that the medical system allowed Tyler鈥檚 family to suffer 鈥渁s a result of his death, and that was quite possibly avoidable. Certainly his medical encounters did not present him with treatment that could have offered him a way out of his situation.鈥�
Hawkins also offered an apology: 鈥淚 am sorry for the part I played in Tyler鈥檚 death and for not addressing his anxiety in an alternative manner at that time. I hope that the changes by both myself and the rest of the medical profession can help to tame this terrible crisis.鈥�
In an interview, Hawkins says using PharmaNet while treating addicted patients with chronic pain is time consuming, especially because it鈥檚 not linked with electronic medical records so doctors must use different systems to get information about any tests and consultations.
鈥淭o try to compare any one visit with another in the past is really challenging, and that鈥檚 before you even see the patient so you鈥檙e exhausted by the time you even enter the room,鈥� says Hawkins, who works in Lake Country, B.C.
鈥淚t could be done electronically, if someone were to program these systems properly,鈥� he says. 鈥漌e need certain things and we鈥檙e just not getting them. I鈥檓 not pretending that it would be easy but there doesn鈥檛 seem to be any effort to make our jobs easier on the front lines.鈥�
Patients suffering from anxiety and depression also require more mental health support so drugs are not the 鈥渆asy鈥� answer, he says.
鈥淚t鈥檚 really sad, with so many young people dying, older people too. Fathers, mothers. It鈥檚 horrendous what鈥檚 going on,鈥� he says of the opioid epidemic that claimed 1,422 lives in British Columbia alone last year, mostly due to street drugs, not prescription medications.
In the end, the college required one of the doctors, not Hawkins, to take a continuing medical education course in Tyler鈥檚 case.
鈥淚t is the college鈥檚 expectation that each of these physicians will use this difficult case as an opportunity for further learning and professional growth for the benefit of future patients and their families,鈥� Dr. K. Shaw of the complaints and practice investigations鈥� inquiry committee wrote to Jennens in a letter dated Jan. 16.
The college told Jennens in a letter a year earlier that if it decided a doctor had 鈥渕ade an isolated error in judgment,鈥� it would take remedial, not disciplinary, action.
鈥淚鈥檓 not out on a witch hunt for doctors,鈥� Jennens says, adding her years of lobbying is aimed at the college and the government to prevent the overprescribing of potentially addictive drugs.
鈥淒octors now thank me for bringing this to their attention,鈥� she says. 鈥淭hey agree we need to do more about PharmaNet. Why didn鈥檛 they just think about this before Tyler died? Why didn鈥檛 someone search his PharmaNet records? Fifty pages of methadone and suboxone prescribed. They had to know it was drug-seeking behaviour.鈥�
In June 2016, as part of revised standards for prescribing drugs that could be misused, the college made the use of PharmaNet mandatory at walk-in and methadone clinics.
Dr. Heidi Oetter, the college鈥檚 registrar and CEO, says the prescription monitoring system was 鈥渂est in class鈥� compared with any other in Canada.
However, she called PharmaNet 鈥渃lunky鈥� and says its ultimate success will require government officials to consult doctors 鈥渢o really make it operational in their offices.鈥�
鈥淲e鈥檙e committed to making access to PharmaNet mandatory once everybody can easily access the system,鈥� Oetter says.
Neither Health Minister Adrian Dix nor Mental Health and Addictions Minister Judy Darcy were available for interviews.
Dr. Trina Larsen Soles, president of Doctors of BC, the association that represents physicians, says PharmaNet should be enhanced to connect with medication records from hospitals, the BC Cancer Agency, the renal program and the HIV-AIDS program.
鈥淚鈥檝e got a cancer patient who鈥檚 on various chemotherapy cocktails and pain meds and I don鈥檛 know what chemo they鈥檙e on because it鈥檚 not on PharmaNet. I have to go to a different window to get that information,鈥� she says. 鈥淵ou鈥檙e doing all this on the screen instead of talking to the patient in front of you.鈥�
Dr. Tom Perry, an internal medicine and clinical pharmacology specialist at the University of British Columbia Hospital, was a New Democrat member of the legislature when PharmaNet was launched in 1995.
鈥淲hat an incredible resource,鈥� he says. 鈥滶veryone should have done it in Canada long ago, and we all should be hooked up to it.鈥�
鈥淚f my records aren鈥檛 perfect, PharmaNet rescues me or anybody else because PharmaNet not only tells you what I prescribed but it tells you what鈥檚 more important, which is did the person fill (the prescription)?鈥�
Dr. Corinne Hohl, an emergency room doctor at Vancouver General Hospital, says installation fees and monthly charges also deter doctors from registering for PharmaNet.
鈥淭his is a big disincentive, I am told, is to pay, and physicians who are private entrepreneurs in private offices simply don鈥檛 want to have to pay the additional fee,鈥� she says.
鈥淚t鈥檚 very beneficial, especially in the context of the current opioid crisis, where we鈥檙e trying to be very careful about prescribing opioids. We want to make sure that the patient is receiving opioids consistently from the same provider as opposed to eight different providers from eight different hospitals if they鈥檙e doctor shopping.鈥�
Camille Bains, The Canadian Press
