November 22, 2017 — New information released by the Canadian Institute for Health Information (CIHI) shows that the quantity of opioids dispensed to Canadians declined between 2012 and 2016. The quantity of opioids is measured by the defined daily dose (DDD), which is the average dose per day for a drug used in adults, according to the World Health Organization (WHO).i
The number of opioid prescriptions has increased over 5 years, but the quantity of opioids in each prescription has decreased. Prescribing lower quantities encourages more frequent interactions between health care providers and their patients, which allows providers to monitor the effectiveness of the drug and the need to continue therapy.
Who is prescribed opioids?
Last year, 21.5 million prescriptions for opioids were dispensed, an increase from 20.2 million prescriptions in 2012. Seniors had the highest rates of opioid prescriptions in Canada between 2012 and 2016, and more than 1 in 5 seniors received at least one opioid prescription last year. The data also shows that 1 in 8 seniors who were prescribed an opioid were prescribed a strong opioid for 90 days or more. A strong opioid is a drug with a higher potency, such as oxycodone, morphine or fentanyl.
Seniors are at greater risk for opioid-related harms due to several factors, including age-related changes in drug absorption and metabolism that may increase the risk of accidental drug poisoning.
What kinds of opioids are prescribed?
6 opioids — codeine, oxycodone, hydromorphone, morphine, tramadol and fentanyl — accounted for more than 96% of all opioids prescribed between 2012 and 2016. Of these, 4 are considered strong opioids (oxycodone, hydromorphone, morphine and fentanyl) and are usually prescribed for moderate to severe pain.
Canadians are increasingly being prescribed strong opioids. In 2016, 57.3% of all opioids prescribed were strong opioids, an increase from 52.2% in 2012. CIHI’s recent report Opioid Harms in Canada highlights that hospitalizations and emergency department visits related to opioid poisonings are increasing — many of which are related to both prescribed and illicit strong opioids.
“The overall quantity of opioids dispensed in Canada is dropping, but people are being prescribed strong opioids more often. Opioids can be an effective way to treat moderate to severe pain, and the risks and benefits should be weighed when prescribing. It is important that we continue to monitor prescribing trends and opioid-related harms as part of our work to help inform public health policy.”
— Brent Diverty, Vice President, Programs, CIHI
“While we are rightly paying close attention to overdose deaths, we need to be looking at a broader range of outcomes: emergency room visits, hospitalizations and prescribing across all age groups. If you put together the rates of prescribing with some of the hospitalization data, it shows we have a serious issue in Canada.”
— Dr. Robert Strang, Chief Medical Officer, Nova Scotia
Our work on opioids
- In November 2016, CIHI’s president and CEO David O’Toole signed a joint statement of action committing CIHI to help address the national opioid crisis.
- CIHI works with the provinces and territories, provincial coroners and medical examiners, partner organizations and other jurisdictions across the country to fill gaps in opioid data, including death statistics that were released by the Public Health Agency of Canada.
- We recently began supporting a rapid response system for tracking opioid-related emergency department visits in Ontario.
- In September 2017, we released our second report on opioid harms in Canada, which includes 2016–2017 data on emergency department visits and hospitalizations due to opioid poisoning.
The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health systems and the health of Canadians. Mental health and addictions is one of CIHI’s priority populations, as outlined in our strategic plan.
We provide comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada. Our stakeholders use our broad range of health system databases, measurements and standards, together with our evidence-based reports and analyses, in their decision-making processes. We protect the privacy of Canadians by ensuring the confidentiality and integrity of the health care information we provide.
i. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC Classification and DDD Assignment 2017. 2017.