Research shows a decline in opioid prescribing across Canadian provinces.

Research shows a decline in opioid prescribing across Canadian provinces.

Effects of efforts to make opioid prescriptions safer in Canada

Efforts to make opioid prescribing safer in Canada appear to be having an impact as new research emergesCMAJ(Canadian Medical Association Journal) show that the distribution of opioids decreased between 2018 and 2022.

What are opioids and why are they important?

Opioids are powerful painkillers often used to treat acute and chronic pain. However, they can also lead to addiction and have caused problems in many countries, including Canada, in recent years.

In the early 2000s, the use of prescription opioids to treat pain increased significantly in Canada, which was accompanied by an increase in opioid-related health harms. The availability of more opioid products and aggressive marketing strategies contributed to these early increases in Canada and other countries.

Opioid Harm Reduction Initiatives

To reduce harm to the population, many initiatives have been launched, including:

• Änderungen der politischen Richtlinien
• Fokus auf kontinuierliche medizinische Weiterbildung für evidenzbasierte Verschreibung
• Eine nationale kanadische Richtlinie für die Verschreibung von Opioiden, veröffentlicht im Jahr 2017

These changes created a need for national information about opioid prescribing in Canada and how it varies across different populations. Researchers sought to address this gap by examining opioid prescribing in 6 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Quebec) between 2018 and 2022. The number of people new to opioid therapy fell by 8% during the study period, and the total number of people receiving opioids fell by 11%. In 2022, approximately 1.8 million people in Canada started using an opioid to manage pain for the first time. However, the prescribing rate varied between provinces, from 55 new opioid starts per 1,000 people in Ontario to 63 per 1,000 people in Alberta.

Differences between provinces

“The differences observed between provinces may indicate variations in the implementation of prescribing guidelines and highlight the need for coordinated national strategies and ongoing evaluation of their impact on patient outcomes,” writes Dr. Tara Gomes, a researcher in the Ontario Drug Policy Research Network at St. Michael's Hospital, Unity Health Toronto, with co-authors.

Who receives opioids?

Annual rates of new prescriptions were higher for women, older adults, and those living in low-income neighborhoods and rural areas. Codeine was commonly prescribed in most provinces, with the exception of Quebec, where morphine and hydromorphone were more commonly dispensed. Dispensing of oxycodone decreased over time, although over a quarter of opioid prescriptions in Ontario were still oxycodone in 2022.

The authors warn that while lower rates of opioid prescribing may reflect physicians' efforts to ensure safe and appropriate prescribing, a balance is needed to ensure that people are not withheld pain medications or cut off from their medications without adequate support and coordination of care.

What happens if opioids are misprescribed?

"Importantly, while these recommendations are intended to promote safer opioid prescribing, improper implementation can result in rapid dose reductions, abrupt discontinuation of opioids, and a reluctance to treat patients with opioids when clinically indicated. In some cases, these changes have resulted in patients attempting to access opioids from the unregulated drug market that are inherently more harmful," the authors write.

The researchers recommend that clinicians have conversations with patients to ensure shared decision-making and to assess pain levels and functional ability.

The reality of opioid dispensing practices

“The truth is... that opioids are less effective and less safe than many would like to admit,” writes Dr. David Juurlink, an internist and researcher at Sunnybrook Research Institute and the University of Toronto, in a related commentary praising the ongoing decline in opioid prescribing.

Although opioids can be effective when prescribed carefully, especially for short periods of time, their effectiveness can decrease with long-term use and they can harm patients in serious ways that are difficult to detect.

“Most clinicians have seen how well opioids can initially work,” writes Dr. Juurlink. "But they are at their best pharmacologically in the first few days of treatment. If you continue them over weeks, months or years, the calculation becomes increasingly unfavorable."

Juurlink calls for thought-provoking prescribing that "begins by recognizing that all patients with pain fall into one of three mutually exclusive groups: those not yet receiving opioids, those taking opioids chronically (sometimes referred to as 'legacy patients'), and those with existing dependence. The latter two groups overlap and can be easily harmed by rapid dose reductions, but they can also be harmed by dose increases. For such patients, as pain increases, strategies are available." without preferring opioids. The first group, on the other hand, has the most to gain from well-thought-out opioid administration.”

This is a poorly thought out conclusion. The levy has fallen because supply from illegal groups has increased. They have not won a victory, but have ignited a fire that will take the lives of many of us. Our experts have never been so incompetent in such competent times. I'm really disappointed to read this. It violates the Hippocratic Oath and is a dereliction of duty. Shame.

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