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Trends in high-dose opioid prescribing in Canada
Tara Gomes1, Muhammad M Mamdani2, J Michael Paterson3
1Scientist 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.
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.
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