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

While Revelstoke has one of the oldest bear awareness societies in the province, the city has yet to implement a community wide bear-proof garbage system. (Submitted)
Saving bears: Revelstoke’s garbage dilemma

More than 400 bears have been killed in the city since 1986

Your Columbia River Revelstoke candidates; Nicole Cherlet (NDP); Samson Boyer (Green) and Doug Clovechok (BC Liberal). The polls are closed and ballots being counted. (File photo)
BC VOTES: Clovechok preliminary winner with 52 per cent of the vote

35 of 77 polls have reported and The Canadian Press is calling Clovechok winner

Firefighters and RCMP are on scene at a fire on Douglas Street. (Jocelyn Doll - Revelstoke Review)
PHOTOS: Firefighters battling blaze on Douglas Street

RCMP are also on scene and blocking off access to the street

The Columbia River Revelstoke riding saw three candidates, Nicole Cherlet for the NDP, Samson Boyer for the Green Party and Doug Clovechok, incumbent, for the BC Liberals. (Jocelyn Doll/Revelstoke Review)
UPDATE: Polls now closed in 2020 provincial election

B.C.’s snap election has already broken records for advance voter turnout, mail-in ballots

NDP headquarters on election night, Oct. 24, 2020. (Katya Slepian/Black Press Media)
ELECTION 2020: Live blog from B.C. party headquarters

BC NDP projected to win majority government – but celebrations will look different this election

NDP Leader John Horgan celebrates his election win in the British Columbia provincial election in downtown Vancouver, B.C., Saturday, Oct. 24, 2020. THE CANADIAN PRESS/Jonathan Hayward
Horgan celebrates projected majority NDP government, but no deadline for $1,000 deposit

Premier-elect says majority government will allow him to tackle issues across all of B.C.

Kelowna Secondary School. (SD23 photo)
One case of COVID-19 identified at Kelowna Secondary School

Interior Health will follow up directly with those who may have been exposed to the virus

BC NDP candidate Harwinder Sandhu offered praise to her team of volunteers (pictured Oct. 21), following a too-close race with BC Liberal and incumbent Eric Foster in the 2020 provincial election Oct. 24. The outcome will be dependent on the final count from mail-in ballots expected in three weeks. (Facebook)
‘Every vote counts’ in tight Vernon-Monashee race: NDP Harwinder Sandhu

Incumbent BC Liberal Eric Foster finishes election night with slim lead

The Independent Investigations Office of BC (IIO)
UPDATE: One dead after Highway 97A crash near Armstrong, police watchdog investigating

The crash happened as RCMP attempted to stop an alleged stolen vehicle

FILE – Prime Minister Justin Trudeau greets Premier John Horgan during a press conference at the BC Transit corporate office following an announcement about new investments to improve transit for citizens in the province while in Victoria on Thursday, July 18, 2019. THE CANADIAN PRESS/Chad Hipolito
Trudeau congratulates Horgan on NDP’s election victory in British Columbia

Final count won’t be available for three weeks due to the record number of 525,000 ballots cast by mail

Comedic actor Seth Rogen, right, and business partner Evan Goldberg pose in this undated handout photo. When actor Seth Rogen was growing up and smoking cannabis in Vancouver, he recalls there was a constant cloud of shame around the substance that still lingers. Rogen is determined to change that. (Maarten de Boer ohoto)
Seth Rogen talks about fighting cannabis stigma, why pot should be as accepted as beer

‘I smoke weed all day and every day and have for 20 years’

Join Black Press Media and Do Some Good

Pay it Forward program supports local businesses in their community giving

Provincial Green Party leader Sonia Furstenau speaks at Provincial Green Party headquarters at the Delta Victoria Ocean Pointe in Victoria. (Arnold Lim / Black Press)
VIDEO: Furstenau leads BC Greens to win first riding outside of Vancouver Island

Sonia Furstenau became leader of BC Greens one week before snap election was called

NDP Leader John Horgan elbow bumps NDP candidate Coquitlam-Burke Mountain candidate Fin Donnelly following a seniors round table in Coquitlam, B.C., Tuesday, October 20, 2020. THE CANADIAN PRESS/Jonathan Hayward
Horgan, NDP head for majority in B.C. election results

Record number of mail-in ballots may shift results

Most Read