Opioid prescriptions dropping in some provinces, report says

About eight per cent fewer people in Ontario, Saskatchewan and British Columbia were prescribed opioids in 2018 than in 2013, an encouraging trend in the opioid crisis, according to a new report.

Last year, about one in eight people were prescribed opioids — based on data from Ontario, Manitoba, Saskatchewan and British Columbia — while only one in 12 started a new opioid therapy.

“This I think is an encouraging trend,” said Michael Gaucher, author of the report and director of pharmaceuticals and health workforce information services at the Canadian Institute for Health Information (CIHI) in Ottawa, which looked at how prescribing practices have changed for opioids, such as codeine, oxycodone and hydromorphone.

“With the opioid crisis and the concern around the quantity of opioids prescribed in Canada, it’s encouraging to really see fewer people starting on opioids,” said Gaucher, a former hospital pharmacist.

The findings translate to about 220,000 fewer people being prescribed opioids in 2018 in the four provinces, and about 175,000 fewer people starting the medications.

As for what might have contributed to the declines, Gaucher pointed to the 2017 introduction of updated prescribing guidelines for opioids, and increased overall awareness during the crisis, which put both prescription and illicit opioids “front and centre.”

Opioids, when prescribed and used appropriately, are for managing pain. But they are also used to produce a high that can lead to hospitalization, death and opioid-use disorders. From January 2016 to June 2018, more than 9,000 Canadians died from apparent opioid-related harms, which the government has called a crisis.

Following high-profile coroners’ cases in Ontario, the first version of Canadian opioid prescribing guidelines were released in 2010. It moved physicians away from increasing doses without a ceiling.

The 2017 update stressed non-pharmacological options such as exercise, pacing and lifestyle changes before trying non-opioid analgesics followed by opioids.

Dr. Norm Buckley, a professor emeritus of anesthesia at McMaster University in Hamilton, said the roots of the crisis trace back to 2007, when it was first recognized that prescription opioids were seeping into the illicit drug market.

He says other potential contributors to the decline in prescribing include:

• An investigation by the College of Physicians and Surgeons in Ontario of 80 physicians identified as high prescribers, which made others anxious about the implications of prescribing opioids.
• British Columbia instituting a prescribing standard, which has been revised, that also focused attention on physician-prescribed opioids.
• Two strongly worded prescribing guidelines that were published in the U.S. in 2017.

“The decline in prescribing is a somewhat predictable result of a push to reduce prescribing, which in part was warranted I think, and in part was perhaps an over swing of the pendulum,” said Buckley, who is also scientific director of the Michael G. DeGroote Institute for Pain Research and Care. He was not involved in the CIHI report.

Buckley said about 15 to 20 per cent of the population experiences chronic pain, such as muscloskeletal low back pain, headache and arthritic conditions. Some chronic pain patients who benefit from their prescribed opioids have said they face misunderstanding at pharmacies and emergency departments because of the stigma associated with opioids.

According to the report, fewer people took opioids on a long-term basis — from 19.8 per cent to 17.6 per cent during that five-year span. (Long-term use was defined as prescribing for 90 days in a 100-day period.)

CIHI said it is challenging to attribute the prescribing trends to specific initiatives since so many have been implemented across the country at different times.

The data in the report covers 60 per cent of Canada’s population. But the findings exclude Quebec, where fewer opioids are prescribed. Buckley said one reason for that might be that Quebec is about 10 years ahead of other provinces in developing a strategy to provide pain care.

During the study period, opioid prescribing rates in Saskatchewan started lower than the other provinces and remained consistently lower. The declines in opioid prescribing were similar in B.C, Manitoba and Ontario, approaching Saskatchewan’s.

Since Manitoba’s data was only available since 2016, it was excluded from calculations on previous years.