. 2014 Sep;60(9):826-32.

Trends in high-dose opioid prescribing in Canada

Tara Gomes¹, Muhammad M Mamdani², J Michael Paterson³, Irfan A Dhalla⁴, David N Juurlink⁵

Affiliations

¹ Scientist at the Institute for Clinical Evaluative Sciences; Assistant Professor at the Institute for Health Policy, Management and Evaluation and the Leslie Dan Faculty of Pharmacy at the University of Toronto; and Scientist at the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto, Ont. gomest@smh.ca.
² Scientist at the Institute for Clinical Evaluative Sciences; Professor at the Institute for Health Policy, Management and Evaluation, the Department of Medicine, and the Leslie Dan Faculty of Pharmacy at the University of Toronto; and Scientist at the Li Ka Shing Knowledge Institute and the Department of Medicine at St Michael's Hospital.
³ Scientist at the Institute for Clinical Evaluative Sciences and Assistant Professor in the Institute for Health Policy, Management and Evaluation at the University of Toronto and the Department of Family Medicine at McMaster University in Hamilton, Ont.
⁴ Scientist at the Institute for Clinical Evaluative Sciences; Assistant Professor at the Institute for Health Policy, Management and Evaluation and the Department of Medicine at the University of Toronto; and Associate Scientist at the Li Ka Shing Knowledge Institute and the Department of Medicine at St Michael's Hospital.
⁵ Scientist at the Institute for Clinical Evaluative Sciences; Scientist at the Sunnybrook Research Institute; and Professor at the Institute for Health Policy, Management and Evaluation, the Department of Medicine, and the Department of Pediatrics at the University of Toronto.

PMID: 25217680
PMCID: PMC4162700

Trends in high-dose opioid prescribing in Canada

Tara Gomes et al. Can Fam Physician. 2014 Sep.

. 2014 Sep;60(9):826-32.

Authors

Tara Gomes¹, Muhammad M Mamdani², J Michael Paterson³, Irfan A Dhalla⁴, David N Juurlink⁵

Affiliations

¹ Scientist at the Institute for Clinical Evaluative Sciences; Assistant Professor at the Institute for Health Policy, Management and Evaluation and the Leslie Dan Faculty of Pharmacy at the University of Toronto; and Scientist at the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto, Ont. gomest@smh.ca.
² Scientist at the Institute for Clinical Evaluative Sciences; Professor at the Institute for Health Policy, Management and Evaluation, the Department of Medicine, and the Leslie Dan Faculty of Pharmacy at the University of Toronto; and Scientist at the Li Ka Shing Knowledge Institute and the Department of Medicine at St Michael's Hospital.
³ Scientist at the Institute for Clinical Evaluative Sciences and Assistant Professor in the Institute for Health Policy, Management and Evaluation at the University of Toronto and the Department of Family Medicine at McMaster University in Hamilton, Ont.
⁴ Scientist at the Institute for Clinical Evaluative Sciences; Assistant Professor at the Institute for Health Policy, Management and Evaluation and the Department of Medicine at the University of Toronto; and Associate Scientist at the Li Ka Shing Knowledge Institute and the Department of Medicine at St Michael's Hospital.
⁵ Scientist at the Institute for Clinical Evaluative Sciences; Scientist at the Sunnybrook Research Institute; and Professor at the Institute for Health Policy, Management and Evaluation, the Department of Medicine, and the Department of Pediatrics at the University of Toronto.

PMID: 25217680
PMCID: PMC4162700

Abstract
in English, French

Objective: To describe trends in rates of prescribing of high-dose opioid formulations and variations in opioid product selection across Canada.

Design: Population-based, cross-sectional study.

Setting: Canada.

Participants: Retail pharmacies dispensing opioids between January 1, 2006, and December 31, 2011.

Main outcome measures: Opioid dispensing rates, reported as the number of units dispensed per 1000 population, stratified by province and opioid type.

Results: The rate of dispensing high-dose opioid formulations increased 23.0%, from 781 units per 1000 population in 2006 to 961 units per 1000 population in 2011. Although these rates remained relatively stable in Alberta (6.3% increase) and British Columbia (8.4% increase), rates in Newfoundland and Labrador (84.7% increase) and Saskatchewan (54.0% increase) rose substantially. Ontario exhibited the highest annual rate of high-dose oxycodone and fentanyl dispensing (756 tablets and 112 patches per 1000 population, respectively), while Alberta's rate of high-dose morphine dispensing was the highest in Canada (347 units per 1000 population). Two of the highest rates of high-dose hydromorphone dispensing were found in Saskatchewan and Nova Scotia (258 and 369 units per 1000 population, respectively). Conversely, Quebec had the lowest rate of high-dose oxycodone and morphine dispensing (98 and 53 units per 1000 population, respectively).

Conclusion: We found marked interprovincial variation in the dispensing of high-dose opioid formulations in Canada, emphasizing the need to understand the reasons for these differences, and to consider developing a national strategy to address opioid prescribing.

Objectif: Décrire les tendances dans les taux de prescription de fortes doses d’opiacés et les variations dans le choix des différents opiacés au Canada.

Type d’étude: Étude transversale de type démographique.

Contexte: Le Canada.

Participants: Des pharmacies au détail qui distribuaient des opiacés entre le 1^er janvier 2006 et le 31 décembre 2011.

Principaux paramètres à l’étude: Les taux de distribution d’opiacés, tels qu’établis d’après le nombre d’unités distribuées par 1000 de population, avec leur répartition par province et par type d’opiacé.

Résultats: Les taux de distribution de formules d’opiacés à des doses élevées a augmenté de 23,0 %, passant de 781 unités par 1 000 de population en 2006 à 961 unités par 1 000 de population en 2011. Alors que ces taux demeuraient stables en Alberta (6,3 % d’augmentation) et en Colombie-Britannique (8,4 % d’augmentation), ils augmentaient de façon importante à Terre-Neuve-Labrador (84,7 % d’augmentation) et en Saskatchewan (54,0 % d’augmentation). C’est en Ontario qu’on observait le plus haut taux annuel de distribution d’oxycodone et de fentanyl en fortes doses (756 comprimés et 112 timbres par 1 000 de population, respectivement), tandis qu’en Alberta, le taux de distribution de fortes doses de morphine était le plus élevé du Canada (347 unités par 1 000 de population). Deux des taux les plus élevés de distribution d’hydromorphone en fortes doses étaient observés en Saskatchewan et en Nouvelle-Écosse (258 et 369 unités par 1 000 de population, respectivement). À l’inverse, le Québec avait le taux le plus faible de distribution d’oxycodone et de morphine en fortes doses (98 et 53 unités par 1 000 de population, respectivement).

Conclusion: Les auteurs ont observé que le taux de distribution de formules d’opiacés en fortes doses variait beaucoup d’une province à l’autre, ce qui montre la nécessité de comprendre les raisons de ces différences et d’envisager une stratégie nationale pour encadrer la prescription d’opiacés.

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Figures

**Figure 1.**
**High-dose opioid dispensing rate (number of units per 1000 population), by province and year (2006–2011):** *Rates are presented nationally and stratified by province.* Data from IMS Brogan Canadian CompuScript database by year between 2006 and 2011.

**Figure 2.**
**High-dose opioid dispensing rate (number of units per 1000 population), by province and opioid type:** *Rates are calculated as the average rate of dispensing between 2006 and 2011.* Data from IMS Brogan Canadian CompuScript database for 2006 to 2011.

See this image and copyright information in PMC

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References

1. International Narcotics Control Board. Opioid consumption motion chart. Madison, WI: Board of Regents of the University of Wisconsin System; 2012. Available from: http://ppsg-production.heroku.com/chart. Accessed 2014 Jul 28.
1. Dhalla IA, Mamdani MM, Sivilotti ML, Kopp A, Qureshi O, Juurlink DN. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ. 2009;181(12):891–6. - PMC - PubMed
1. Boudreau D, Von KM, Rutter CM, Saunders K, Ray GT, Sullivan MD, et al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf. 2009;18(12):1166–75. - PMC - PubMed
1. Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med. 2006;31(6):506–11. - PubMed
1. Gomes T, Juurlink DN, Dhalla IA, Mailis-Gagnon A, Paterson JM, Mamdani MM. Trends in opioid use and dosing among socio-economically disadvantaged patients. Open Med. 2011;5(1):e13–22. - PMC - PubMed

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Trends in high-dose opioid prescribing in Canada

Affiliations

Trends in high-dose opioid prescribing in Canada

Authors

Affiliations

Abstract
in English, French

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Abstract in English, French

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Abstract
in English, French