Prescription pills containing oxycodone and acetaminophen are shown in Toronto, Nov. 5, 2017. THE CANADIAN PRESS/Graeme Roy

Prescription pills containing oxycodone and acetaminophen are shown in Toronto, Nov. 5, 2017. THE CANADIAN PRESS/Graeme Roy

Opioid prescriptions up across Canada: report

The report shows the number of opioid prescriptions rose by almost seven per cent, while daily doses on average dropped

The overall number of prescriptions for opioids has increased over the last five years, but doctors have been giving patients fewer doses at one time, a report by the Canadian Institute for Health Information has found.

The report, released Wednesday, shows the number of opioid prescriptions rose by almost seven per cent between 2012 and 2016, while daily doses on average dropped by five per cent — to 226 million from 238 million.

Last year, 21.5 million prescriptions for the potent painkillers were dispensed, up from 20.2 million prescriptions in 2012, CIHI reported. Most were for chronic non-cancer pain relief.

“Opioid prescriptions are still going up, but the encouraging trend we’re seeing is the quantity of doses that are being dispensed is going down,” said Michael Gaucher, director of pharmaceuticals and health workforce information services at CIHI.

Related: ‘Canada needs a better approach:’ Health groups want alternatives to opioids

“When you put those two together, it’s encouraging in that the fewer doses being dispensed per prescription means that these drugs are being reviewed more regularly and potentially stopped or at least being assessed and switched perhaps to another mode of pain management,” he said.

However, the report also found that Canadians are increasingly being prescribed stronger opioids. In 2016, about 57 per cent of all opioids prescribed were high-potency; four years earlier, that figure was 52 per cent.

Canadians 65 and older were those most often prescribed opioids over the four-year period covered by the report, Gaucher said.

“When we looked at how often they were being prescribed in the different age groups, about one in five seniors received at least one opioid prescription in a given calendar year.”

CIHI data also show that one in eight seniors prescribed an opioid were put on a high-potency drug — such as oxycodone, morphine or the fentanyl patch — for 90 days or longer, he said, noting that the stronger opioids are generally used to relieve more severe pain.

“There are a lot of negative outcomes from prescribing opioids to seniors that go beyond death,” said Dr. Robert Strang, co-chair of the federal-provincial Special Advisory Committee on the Epidemic of Opioid Overdoses.

“There are substantive negative impacts on people’s lives,” Strang, Nova Scotia’s chief medical officer of health, said in a release.

Seniors are at greater risk for opioid-related harms due to several factors, including age-related changes in drug absorption and metabolism, and cognitive changes that may increase the risk of accidental drug poisoning.

The report said six types of the powerful narcotics — codeine, tramadol, oxycodone, hydromorphone, morphine and the fentanyl patch — accounted for more than 96 per cent of all opioids prescribed between 2012 and 2016. Of these, the last four are typically given for moderate to severe pain.

Related: Federal government to boost treatment options for opioid drug users: minister

Gaucher said it’s unclear what’s driving the use of high-potency opioids, but the greying of the population and the attendant pain-inducing medical conditions that accrue with age could be a factor.

Since 2012, the number of prescriptions for strong opioids other than the fentanyl patch jumped by 19 per cent, while fentanyl prescriptions declined by almost seven per cent.

Gaucher doesn’t know why the fentanyl patch has fallen somewhat out of favour. But he speculated that the high number of overdose deaths, many linked to illicit fentanyl, may have raised both physician and patient awareness of the potency of the prescription form of the drug and its potential harms, leading to reduced use.

In June, the Public Health Agency of Canada reported 2,458 apparent opioid-related deaths for the previous year across the country (excluding Quebec). More than 900 of those fatalities occurred in British Columbia.

Concern over overdoses with a strong opioid such as the fentanyl patch may have left doctors wondering: “Is it the best choice or is there another choice that may be better?” Gaucher suggested.

CIHI also found that opioid prescribing practices varied across the country, with Quebec and British Columbia reporting the lowest number of daily doses per 1,000 residents (3,601 and 5,496, respectively) and Alberta (7,955) and Newfoundland and Labrador (7,878) the highest.

Quebec’s figure is not only the lowest in the country, it’s almost half of the Canadian average of 6,110 daily doses per 1,000 people.

“This new report rightly points out that we need to look at Quebec in much more detail and try to figure out why it’s so different from the rest of the country with regard to opioid prescribing,” said Strang.

While it’s not known why Quebec has such low dose-dispensing levels relative to the rest of the country, Gaucher said demographics, overall population health status and prescribing practices by physicians could all play a role.

“But part of it could just be increased awareness of prescribers and the attention they’re paying to managing pain with opioids, given the crisis situation.”

Both B.C. and Nova Scotia adopted opioid prescribing guidelines in 2015, and both experienced decreases in dispensing a year later, with daily doses per 1,000 population declining by almost 12 per cent in B.C. and by six per cent in Nova Scotia.

Related: Physiotherapy could help combat B.C.’s opioid crisis: report

Strang said it would be ideal to see a marked reduction in the prescribing of all opioids, especially high-potency formulations.

“(But) we have to acknowledge that this is a balancing act,” he said. “While we’re trying to reduce the prescribing of opioids overall, we have to recognize that there are people who, for a very significant period of time, have been dependent on strong opioids.

“We’re not going to change that overnight.”

Sheryl Ubelacker, The Canadian Press

Like us on Facebook and follow us on Twitter.

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Greg Chow is the 2021 Local Hero of the Year. (Don Denton/Black Press Media)
Fighting fire a family affair for Colwood Assistant Chief Greg Chow

With 38 years of service, Greg Chow is the 2021 Hero of the Year

(Black Press Media file photo)
B.C. residents can reserve provincial camp sites starting March 8

B.C. residents get priority access to camping reservations in province

The Gordon Head Recreation Centre stands in as the Quimper Regional Hospital on Feb. 23 for filming Maid, a 10-part Netflix series. (Greg Sutton/District of Saanich)
Netflix transforms Saanich recreation centre into hospital for filming

Facility was closed to public Feb. 23 for filming of Maid

Sooke Road was down to single lane alternating traffic after a motor vehicle incident Wednesday morning. (Google Maps)
UPDATED: Sooke Road reopen after motor vehicle incident

Emergency crews were on scene of Wednesday morning incident

Dr. Bonnie Henry talk about the next steps in B.C.'s COVID-19 Immunization Plan during a press conference at Legislature in Victoria, B.C., on Friday, January 22, 2021. THE CANADIAN PRESS/Chad Hipolito
456 new COVID-19 cases in B.C., 2 deaths

Since January 2020, 78,278 have tested positive for the novel coronavirus in B.C.

Anyone with information on any of these individuals is asked to call 1-800-222-TIPS (8477) or visit the website victoriacrimestoppers.ca for more information.
Greater Victoria Crime Stoppers wanted list for the week of Feb. 23

Greater Victoria Crime Stoppers is seeking the public’s help in locating the… Continue reading

(Black Press Media File Photo)
POLL: Are you struggling with Greater Victoria’s cost of housing?

While Victoria remains one of the most expensive cities in the country… Continue reading

A health-care worker prepares a dose of the Pfizer-BioNTech COVID-19 vaccine at a UHN COVID-19 vaccine clinic in Toronto on Thursday, January 7, 2021. (THE CANADIAN PRESS/Nathan Denette)
Vaccinating essential workers before seniors in B.C. could save lives: experts

A new study says the switch could also save up to $230 million in provincial health-care costs

The late Michael Gregory, 57, is accused of sexually exploiting six junior high students between 1999 and 2005. (Pixabay)
Former Alberta teacher accused of sexually assaulting students found dead in B.C.

Mounties say Michael Gregory’s death has been deemed ‘non-suspicious’

According to a new poll, a majority of Canadians want to see illicit drugs decriminalized. (THE ASSOCIATED PRESS)
Majority of Canadians think it’s high time to decriminalize illicit drugs: poll

More than two-times the B.C. residents know someone who died from an overdose compared to rest of Canada

Photograph By @KAYLAXANDERSON
VIDEO: Lynx grabs lunch in Kamloops

A lynx surprises a group of ducks and picks one off for lunch

Two women were arrested in Nanaimo for refusing to wear masks and causing disturbance on a BC Ferries vessel. (File photo)
B.C. ferry passengers arrested and fined for disturbance, refusing to wear masks

Police said woman threatened their pensions in Feb. 21 incident aboard Nanaimo-bound boat

When his owner had knee surgery, Kevin, 2, was able to continue to go for walks thanks to volunteers from Elder Dog Canada. (Contributed photo)
B.C. woman has nothing but praise for Elder Dog Canada

National organization has a fleet of volunteer walkers ready, but needs more clients to serve

Most Read