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. 2022 Dec 8;17(12):e0278508.
doi: 10.1371/journal.pone.0278508. eCollection 2022.

Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study

Tara Gomes  1   2   3   4 , Siyu Men  2 , Tonya J Campbell  1 , Mina Tadrous  3   5 , Muhammad M Mamdani  1   2   3   4 , J Michael Paterson  2   4   6 , David N Juurlink  2   4
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Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study

Tara Gomes et al. PLoS One. .

Abstract

Introduction: The recent publication of a national guideline and quality standards in Canada have provided clinicians with new, evidence-based recommendations on safe, appropriate opioid use. We sought to characterize how well opioid initiation practices aligned with these recommendations before and following their release.

Methods: We conducted a population-based study among people initiating opioids prior to the release of national guidelines (April 2015-March 2016; fiscal year [FY] 2015) and in the most recent year available (January-December 2019) in Ontario, Canada. We used linked administrative claims data to ascertain the apparent indication for opioid therapy, and characterized the initial daily dose (milligrams morphine or equivalent; MME) and prescription duration for each indication.

Results: In FY2015, 653,885 individuals commenced opioids, compared to 571,652 in 2019. Over time, there were small overall reductions in the prevalence of initial daily doses exceeding 50MME (23.9% vs. 20.1%) and durations exceeding 7 days (17.4% vs. 14.8%); but the magnitude of the reductions varied widely by indication. The prevalence of high dose (>50MME) initial prescriptions reduced significantly across all indications, with the exception of dentist-prescribed opioids (13.6% vs. 12.1% above 50MME). In contrast, there was little change in initial durations exceeding 7 days across most indications, with the exception of some surgical indications (e.g. common excision; 9.3% vs. 6.2%) and among those in palliative care (35.2% vs. 29.2%).

Conclusion: Despite some modest reductions in initiation of high dose and long duration prescription opioids between 2015 and 2019, clinical practice is highly variable, with opioid prescribing practices influenced by clinical indication. These findings may help identify medical specialties well-suited to targeted interventions to promote safer opioid prescribing.

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Conflict of interest statement

Dr. Muhammad Mamdani has received honoraria from Boehringer Ingelheim, Pfizer, Mristol-Myers Squibb, and Bayer. Dr. David Juurlink has received payment for lectures and medicolegal opinions regarding the safety and effectiveness of analgesics, including opioids. He is a member of Physicians for Responsible Opioid Prescribing, a volunteer organization that seeks to reduce opioid-related harm through more cautious prescribing practices. Dr. Gomes has received grant funding from the Ontario Ministry of Health. No other authors have any conflicts of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Cohort inclusion and exclusion criteria: Fiscal year 2015/16 cohort.
Note that the antidiarrheal exclusion is noted here as it was not originally part of the exclusion criteria in Pasricha et al. and therefore required further exclusion for this analysis.
Fig 2
Fig 2. Cohort inclusion and exclusion criteria: Calendar year 2019 cohort.
See this image and copyright information in PMC

References

    1. Government of Canada. Opioid and Stimulant-Related Harm in Canada 2020 https://health-infobase.canada.ca/substance-related-harms/opioids-stimul....
    1. U.S. Centers for Disease Control and Prevention. Opioid Data Analysis and Resources 2021 https://www.cdc.gov/drugoverdose/data/analysis.html.
    1. Public Health Ontario. Interactive Opioid Tool: Opioid-related morbidity and mortality in Ontario: Public Health Ontario; 2019 https://www.publichealthontario.ca/Data%20and%20Analysis/Substance%20Use....
    1. Gomes T, Juurlink DN. Understanding the Implications of a Shifting Opioid Landscape in Ontario. Healthc Q. 2019;22(3):6–11. doi: 10.12927/hcq.2019.26025 - DOI - PubMed
    1. U.S. Centers for Disease Control and Prevention. Understanding the Epidemic 2020 https://www.cdc.gov/drugoverdose/epidemic/index.html.

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