VANCOUVER — Helen Jennens flips through two sets of documents — 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.'s 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.
Jennens, who lives in Kelowna, 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.
"Both boys, I have no idea how they lived as long as they did, with the medications they were prescribed, the combinations they were prescribed," 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's home with a pot of chili and found him propped up on his bed with his computer on his lap. He'd 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'd warned doctors Rian could become hooked on opioids because he'd endured a decade of addiction that included cocaine and crystal meth.
"He was eight years drug free when he got into that accident. I said, 'We know legitimately he needs stuff for pain because his leg was shattered but we also have to stay on top of it.' "
After Rian died, Jennens requested his PharmaNet records and questioned why he was prescribed such a wide range of medications including opioids.
"Why didn't these people say enough? That was my whole issue with PharmaNet," Jennens says. "It lets you know somebody's got a drug history. He's on this cocktail for three years and nobody is concerned about what may happen in terms of overdose?"
A big part of Jennens's complaint with the College of Physicians and Surgeons focuses on mandating the use of PharmaNet, which she says could be optimized to protect patients.
"That didn't happen, and five years later, my second son died," 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's bathroom, where he was found dead on the floor. A coroner's report says he had overdosed on the powerful opioid.
"He used to lay in my lap at night and say, 'Remember when I played football? Why can't I get that back?' " Jennens says. "His sister saw him twice in the last three years of his life because she wouldn't subject her daughter to his behaviour, and it killed him. It's killing her now."
Armed with 173 pages of PharmaNet records listing Tyler's medications, Jennens filed a second complaint and "pleaded" with the college to make the use of PharmaNet compulsory for all doctors.
Jennens' 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's death prompted them to use it.
Dr. David Hawkins says in his letter that the medical system allowed Tyler's family to suffer "as 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."
Hawkins also offered an apology: "I am sorry for the part I played in Tyler's 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."
In an interview, Hawkins says using PharmaNet while treating addicted patients with chronic pain is time consuming, especially because it's not linked with electronic medical records so doctors must use different systems to get information about any tests and consultations.
"To try to compare any one visit with another in the past is really challenging, and that's before you even see the patient so you're exhausted by the time you even enter the room," says Hawkins, who works in Lake Country, B.C.
"It could be done electronically, if someone were to program these systems properly," he says. "We need certain things and we're just not getting them. I'm not pretending that it would be easy but there doesn't seem to be any effort to make our jobs easier on the front lines."
Patients suffering from anxiety and depression also require more mental health support so drugs are not the "easy" answer, he says.
"It's really sad, with so many young people dying, older people too. Fathers, mothers. It's horrendous what's going on," 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's case.
"It is the college's 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," Dr. K. Shaw of the complaints and practice investigations' 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 "made an isolated error in judgment," it would take remedial, not disciplinary, action.
"I'm not out on a witch hunt for doctors," Jennens says, adding her years of lobbying is aimed at the college and the government to prevent the overprescribing of potentially addictive drugs.
"Doctors now thank me for bringing this to their attention," she says. "They agree we need to do more about PharmaNet. Why didn't they just think about this before Tyler died? Why didn't someone search his PharmaNet records? Fifty pages of methadone and suboxone prescribed. They had to know it was drug-seeking behaviour."
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's registrar and CEO, says the prescription monitoring system was "best in class" compared with any other in Canada.
However, she called PharmaNet "clunky" and says its ultimate success will require government officials to consult doctors "to really make it operational in their offices."
"We're committed to making access to PharmaNet mandatory once everybody can easily access the system," 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.
"I've got a cancer patient who's on various chemotherapy cocktails and pain meds and I don't know what chemo they're on because it's not on PharmaNet. I have to go to a different window to get that information," she says. "You're doing all this on the screen instead of talking to the patient in front of you."
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.
"What an incredible resource," he says. "Everyone should have done it in Canada long ago, and we all should be hooked up to it."
"If my records aren't perfect, PharmaNet rescues me or anybody else because PharmaNet not only tells you what I prescribed but it tells you what's more important, which is did the person fill (the prescription)?"
Dr. Corinne Hohl, an emergency room doctor at Vancouver General Hospital, says installation fees and monthly charges also deter doctors from registering for PharmaNet.
"This is a big disincentive, I am told, is to pay, and physicians who are private entrepreneurs in private offices simply don't want to have to pay the additional fee," she says.
"It's very beneficial, especially in the context of the current opioid crisis, where we're 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're doctor shopping."
SOME FACTS ABOUT B.C.'S PHARMANET AS A MOTHER CALLS FOR BETTER USE OF SYSTEM
VANCOUVER — Some facts about PharmaNet, British Columbia's unique network that records information about prescription medications:
— PharmaNet was launched by the Health Ministry in 1995 mostly as a billing system, but it became recognized as a valuable tool to access prescription records.
— PharmaNet has been available in emergency departments since the 1990s.
— The College of Physicians and Surgeons of British Columbia made its use compulsory in walk-in clinics and methadone clinics in 2016 after the province declared a public health emergency in response to increasing overdose deaths.
— Doctors say PharmaNet has great potential but an installation fee, monthly charges of about $10, and its time-consuming process are disincentives.
— The college says it is committed to making PharmaNet use mandatory for all doctors but the government must first enhance the system to allow for quick access.
— The Ministry of Mental Health and Addiction says as of December 2017, about 6,500 physicians working in private community practice were eligible for PharmaNet, but only 3,918 have access to the system. It says work is underway to develop an improved prescription monitoring program.
— Beth Sproule, a pharmacist and clinician scientist at the Centre for Addiction and Mental Health, says many provinces now have drug information systems but unlike PharmaNet, they do not provide real-time data to doctors: "The provinces are talking to each other, looking at best practices. There's a lot of work going on, looking at the prescription monitoring side of things."
