Post-op becomes a real pain in the knee

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This article was published 26/08/2023 (791 days ago), so information in it may no longer be current.

Manitoba’s failure to follow a federal exemption for prescription drugs meant a Winnipeg Beach resident was temporarily without painkillers after her out-of-province knee replacement earlier this month.

Janice Scott went to Fort Frances, Ont. for the day surgery and was prescribed post-op hydromorphone to manage the pain during her recovery.

“No pharmacy in Manitoba could fill that prescription, so I went a week on less than three days’ (worth of) necessary pain-killing medication,” Scott said.

“That was a terrible first week.”

Scott said she was told she wasn’t the only one to experience this “made-in-Manitoba problem.”

Manitoba is the only province that hasn’t enacted a federal exemption to Canadian law governing controlled substances. To better allow patients to get prescription drugs delivered, have prescriptions renewed and have prescriptions transferred to different pharmacies during the pandemic, the federal government issued an exemption in 2021 to the Controlled Drugs and Substances Act.

Before the pandemic, prescriptions for narcotics and other controlled substances couldn’t be transferred between pharmacies or between jurisdictions. The new federal rule has been extended to 2026, although it was introduced as a temporary measure in response to the opioid overdose crisis.

Provinces and territories had to change their own regulations in order for the federal exemption to take effect; Manitoba and Nunavut haven’t done so.

Pharmacists have been lobbying the provincial government to get on board, saying the failure to enact the exemption puts an additional administrative burden on medical practitioners and pharmacists and creates needless confusion and frustration for patients.

“Frankly, it’s a waste of health-care resources, and more importantly, it’s an inconvenience and a frustration to the patient who’s already probably going through somewhat of a stressful situation,” said Tim Smith, pharmacy practice adviser with Pharmacists Manitoba.

“We, along with the College of Pharmacists of Manitoba, have been pushing for this regulatory change because of circumstances like this, where people end up being without medication that they might really need.”

In Scott’s case, she had only extra-strength Tylenol handy during a long weekend while she scrambled to find a Manitoba practitioner who would write her the same prescription she already had from Ontario. She managed to get a new prescription from a local nurse practitioner, but not before her Ontario-prescribed hydromorphone opioid ran out.

“It created huge anxiety, not to mention unnecessary extra pain,” she said.

As for why Manitoba hasn’t enacted the federal exemption, a spokesperson for Health Minister Audrey Gordon’s office directed questions to the College of Pharmacists of Manitoba.

The college has previously stated it would “continue working with the provincial government on full implementation of these exemptions,” according to information issued to members in 2021, and posted online. A representative for the regulatory body couldn’t be reached for comment Friday.

Asked if Manitoba’s Diagnostic and Surgical Recovery Task Force has addressed concerns about prescription drug restrictions for patients who’ve gone out of province for surgery, the health minister’s office didn’t directly respond.

A government spokesperson said pre-op and post-op care is mapped out for each patient receiving medical care out of province.

“This care is supervised by a Medical Director, who is a Manitoba doctor, that oversees care pathways and any care quality issues including prescription drugs. Patients are encouraged to follow up with their Patient Navigator and/or their Manitoba provider as soon as possible, as they would if having surgery within the province.”

Scott’s surgery went well. She was admitted to the Fort Frances hospital at about 8:30 a.m. Aug. 2 and discharged at 5:30 p.m. the same day. She and her husband stayed overnight at a hotel afterward before hitting the road for a roughly six-hour drive home. After the surgery, she was given a 48-hour nerve block via a catheter into her knee, which worked to dull her pain temporarily. Her supply of prescribed painkillers she’d had filled at a Fort Frances pharmacy — $110 paid for out of pocket — was intended to last about three days. But Scott rationed the pills. She’d been given a refill order with her prescription, but the refill couldn’t be provided until a certain amount of time had passed, so she was required to wait until after she returned home to get more medication.

She now describes her experience as “pain mismanagement” and said the prescription problem is an oversight that needs to be corrected.

She opted to have surgery in Ontario because she faced a 12- to 15-month wait in Manitoba and was opposed to going to the U.S., saying she doesn’t agree with spending Canadian tax dollars in the American health-care system.

“I think there’s something so politically, philosophically, morally not right about that,” she said.

She chose to go to Fort Frances over Kenora, hoping for a shorter wait. The hotel stay and gas coverage amounted to approximately $1,000, including a per diem for food for her and her husband.

Scott said she still struggles with feeling guilty for incurring the extra expense for the province, but she says she also went to a lot of trouble to make the arrangements, dealing with phone call after phone call from officials and keeping things organized.

The process wasn’t as smooth as it could have been, Scott said. A few days after she returned home post-surgery, she received a letter in the mail from the task force suggesting she look into having an out-of-province surgery: “our records indicate you are on a surgical waitlist …”

“I really did feel that I was on my own a lot of the time,” she said.

Still, Scott said she’s grateful the option for out-of-province surgery exists.

“It was a really hard decision, on one hand. My pain level — I wasn’t sleeping anymore. My one form of exercise was in the water, (and) it hurt in the water. The thing about it is, you’re not just waiting at a standstill. Every day, it’s getting worse,” she said.

“My options were running out.”

katie.may@winnipegfreepress.com