While Canada continues to experience an opioid crisis, opioid prescribing practices are changing across the country. Fewer people are starting opioid prescriptions and using opioids long term. In 2017, almost 1 in 8 people were prescribed opioids.
New data from the Canadian Institute for Health Information (CIHI) shows that fewer people started opioid prescriptions, with rates declining from 9% to 4% between 2013 and 2017. Although decreases occurred across all age groups, the largest decline was among seniors age 65 and older.
In 2017, most people (69%) who started opioids were prescribed them for less than 1 week, compared with 63% in 2013.
Declines in long-term opioid use
CIHI’s report also found that among people prescribed opioids, the rate of those on long-term opioid therapy declined from 20% to 19%. Long-term therapy is defined as prescribing someone opioids for 90 days in a 100-day period. Many people on long-term opioid therapy took smaller doses or stopped taking opioids completely.
Impact of prescribing guidelines
The overall rate of opioids prescribed to Canadians decreased slightly, from 14% to 13% between 2013 and 2017. Many initiatives, including Canadian opioid prescribing guidelines, provincial prescription monitoring programs and changes to prescription coverage, were implemented to help reduce opioid harms.
These initiatives and increased awareness about opioid harms are likely influencing prescribing trends. However, it is challenging to attribute specific initiatives to data trends since many initiatives have been implemented across the country at different times.
“We’re seeing changes in opioid prescribing, which indicate that harm reduction initiatives may be having a positive impact. Opioids, when prescribed and used appropriately, are effective drugs that play an important role in pain management, and it is essential that patients who need them receive therapy. However, safe and appropriate prescribing of opioids is only part of the solution, as illicit opioids continue to be a big part of the crisis.”— Michael Gaucher, Director, Pharmaceuticals and Health Workforce Information Services, CIHI
“CIHI’s report identifies information gaps and highlights the need to continue to extend the breadth of coverage and connectivity among opioid prescription monitoring programs across the country. The reduction in prescriptions’ durations and the total amount of opioids prescribed is likely influenced by the first Canadian opioid guideline from 2010, as well as other knowledge translation efforts. However, it continues to be challenging to ensure that patients who will benefit from opioids still receive them. There is no diagnostic coding to identify patients with chronic pain, so it is difficult to establish whether prescribing has been appropriate.”— Dr. Norm Buckley, Professor, Department of Anesthesia; Scientific Director, Michael G. DeGroote Institute for Pain Research and Care; and Director, Michael G. DeGroote National Pain Centre; McMaster University
The data collected analyzes opioid prescribing trends for Ontario, Manitoba, Saskatchewan and British Columbia and represents about 60% of Canadians. These 4 provinces were the only ones where CIHI had access to data on all prescription opioids dispensed in community pharmacies.
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