Dr. Tara Gomes

In the early 2000s, use of prescription opioids to treat acute and chronic non-cancer pain increased substantially in Canada, and with it came a rise in opioid-related harms. The availability of more opioid products, coupled with aggressive marketing of these drugs, contributed to these early increases in Canada and in other countries.

Many initiatives have been introduced with the goal of reducing these harms throughout the country, including policy changes, a focus on continuing medical education for evidence-based prescribing, and a national Canadian guideline for opioid prescribing published in 2017. 

With these changes, a need has emerged for national information on prescription opioid use in Canada and how this varies in different parts of the population.

In a study by St. Michael’s researchers published Monday in the Canadian Medical Association Journal (CMAJ), the number of people newly starting opioids declined 8 per cent during the study period, and the total number of people accessing opioids declined 11 per cent.

Enjoying this story? Sign up for the Unity Health Toronto newsletter, a monthly update on the latest news, stories, patient voices and research emailed directly to subscribers.

In 2022, across Canada, approximately 1.8 million people started an opioid to manage pain for the first time. However, the rate of opioid prescribing varied among provinces, ranging from 55 new opioid starts per 1,000 people in Ontario to 63 per 1,000 people in Alberta.

“[T]he interprovincial variations in our findings may indicate differences in the implementation of prescribing guidelines, underscoring the need for coordinated national strategies and ongoing evaluation of their effects on patient outcomes,” writes Dr. Tara Gomes, a researcher in the Ontario Drug Policy Research Network at St. Michael’s Hospital, a site of Unity Health Toronto, with coauthors.

Annual rates of new prescriptions were higher for females, older adults, and people living in lower-income neighbourhoods and rural regions. Codeine was most usually prescribed in most provinces, with the exception of Quebec, where people were more commonly dispensed morphine and hydromorphone. Oxycodone dispensing decreased over time, although in Ontario over one-quarter of opioids prescribed were still for oxycodone in 2022.

The authors caution that although lower rates of opioid prescribing may reflect doctors’ efforts to ensure safe and appropriate prescribing, a balance is needed to ensure that people are not left without pain relief or cut off from medications without appropriate supports and coordination of care.

“Importantly, although these recommendations intended to promote safer opioid prescribing, improper implementation can lead to rapid dose tapering, abrupt opioid discontinuation, and reluctance to initiate patients on opioids when clinically indicated. In some cases, these changes have led to patients seeking access to opioids from the unregulated drug supply, which are inherently more harmful,” write the authors.

By: Kim Barnhardt, CMAJ

Related Tags