Abstract
BackgroundInto the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005–2020.MethodsRaw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for ‘strong’ and ‘weak’ opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing.ResultsAll provinces reported starkly increasing strong opioid dispensing peaking 2011–2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of > 100 %; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control.ConclusionsWe characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.
Highlights
The transition into the 21st century marked a turning point for chronic pain and related opioid pharmacotherapy in North America, and Canada
Strong opioids [see Fig. 1 for data visualization] In 2005, the lowest strong opioid dispensing rate was reported by Manitoba (MN;3.9 defined daily dose (DDD)/1,000/day), and the highest by QC Quebec (Ontario) (ON;10.1 DDD/1,000/day), translating into an inter-provincial range of difference of 159 %
The highest ‘peak’ value for opioid dispensing was reported by ON (14.2 DDD/1,000/day), and the lowest ‘peak’ value by QC (6.6 DDD/1,000/day), indicating a total interprovincial range of difference of 115 % for ‘peak’ levels
Summary
The transition into the 21st century marked a turning point for chronic pain and related opioid pharmacotherapy in North America, and Canada . A vocal socio-medical movement had begun to propagate chronic pain as a neglected ‘fifth vital sign’, advocating for systematic expansions of improved treatment and care [3, 4], including more generous utilization of opioid pharmacotherapy options generally considered “safe and efficacious” [1]. Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioidrelated adverse (e.g., morbidity/mortality) outcomes. Trends and determinants of opioid dispensing in Canada, and its 10 provinces, for the years 2005–2020
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