Fentanyl, a synthetic opioid painkiller, is flooding the illegal drug market and has been involved in a rash of drug overdoses across Canada. (CBC)

A Nova Scotia pain management specialist says doctors bear some of the responsibility to prevent patients from developing addictions to painkillers and other medications — and it starts with the first prescription.

"I think the prescribing physicians or nurse practitioner as the case may be, always has a responsibility to assess the patient carefully beforehand," said Dr. Peter MacDougall, an anaesthesiologist in Halifax.

He says doctors must monitor patients to see how the medication is working, to assess any side effects and to determine if they're developing any other illnesses, one of which can be addiction.

Fentanyl in spotlight

The drug fentanyl is causing alarm across the country. It's considered a hundred times powerful than heroin.

MacDougall says if a patient with a substance abuse disorder starts mixing drugs, doctors must try to have an honest discussion about it.

Dr. Peter MacDougall says doctors must assess their patients before prescribing drugs and continue to monitor the effect of medications. (CBC)

MacDougall adds there's a growing recognition in the medical community that new prescribing practices are needed to address addiction.

He says one of the goals now is to prepare new physicians to assess patients and monitor them carefully.

"How to manage these drugs more carefully to try and reduce the impact, or at least the negative impact of these medications on the public at large, and to reduce the effect of addiction on the population at large," he said.

Frank discussions

While it can take time, he says doctors can do much more to help patients who want to kick the habit. He says the length of the process may depend on how long people have been taking medication and what quantity they're consuming.

"Weaning patients off of these pain medications is not always easy, but it certainly can and should be done in many cases," said MacDougall.

Ultimately, he says addressing addiction starts with doctors understanding their role in helping to prevent dependency issues from starting in the first place.

"The problem here is somewhat at the front end, thinking about how we use these medications in a trial, and how we assess the patients beforehand to assess their risk of addiction. That in itself is a skill."