Trends and changes in prescription opioid analgesic dispensing in Canada 2005–2012: an update with a focus on recent interventions

Benedikt Fischer,Wayne Jones,Jürgen Rehm

doi:10.1186/1472-6963-14-90

Abstract

BackgroundPrescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. Canada features the world’s second-highest POA consumption rates. Following increases in POA-related harm, several POA control interventions have been implemented since 2010.MethodsWe examined trends and patterns in POA dispensing in Canada by province for 2005–2012, including a focus on the potential effects of interventions. Data on annual dispensing of individual POA formulations – categorized into ‘weak opioids’ and ‘strong opioids’ – from a representative sub-sample of 5,700 retail pharmacies across Canada (from IMS Brogan’s Compuscript) were converted into Defined Daily Doses (DDD), and examined intra- and inter-provincially as well as for Canada (total).ResultsTotal POA dispensing – driven by strong opioids – increased across Canada until 2011; four provinces indicated decreases in strong opioid dispensing; seven provinces indicated decreases specifically in oxycodone dispensing, 2011–2012. The dispensing ratio weak/strong opioids decreased substantively. Major inter-provincial differences in POA dispensing levels and qualitative patterns of POA formulations dispensed persisted. Previous increasing trends in POA dispensing were reversed in select provinces 2011–2012, coinciding with POA-related interventions.ConclusionsFurther examinations regarding the sustained nature, drivers and consequences of the recent trend changes in POA dispensing – including possible ‘substitution effects’ for oxycodone reductions – are needed.

Highlights

Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere
First, our analyses extend observations about key patterns and trends in POA dispensing in Canada observed in earlier examinations [18]
As a limitation of these analyses, community dispensing accounts only for a part of POA dispensing in Canada; in addition, dispensing amounts do not necessarily equate consumption data yet are a best available and closest measurable proxy indicator of POA consumption. In sum, both the key drivers behind, yet especially various key consequences of the observed recent changes in POA dispensing in Canada, need to be systematically evaluated from both clinical and population health perspectives, given the strong evidence that POA dispensing levels are closely associated with levels of key harm (e.g., non-medical prescription opioid use (NMPOU) morbidity, mortality) indicators [14,15,16,53]

Summary

Introduction

Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. The global utilization of prescription opioid analgesics (POAs) – principal medications for pain care – has sharply increased in recent years. About 90% of all POAs are consumed in established market economies (EMEs), and >80% of the world’s population – mainly in low or middle income an environment of medical care where pharmaceutical interventions are commonly privileged by providers and desired by patients over other interventions [5,6,7,8]. The high and rising POA use rates in Canada – similar to the US – have been paralleled by substantive levels of POA-related morbidity and mortality [4]. Levels of POA availability have been shown to be strongly correlated with levels of POA-related morbidity and mortality, constituting a principal driver for POA-related harm on a population level [10,14,15,16,17]

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