TORONTO – Reformulary Group, a Canadian healthcare technology company, today released a report on opioid prescribing in Canada. The report analyzes the data of over six million prescription Canadians that submitted a drug claim from 2013 to 2017 to address the impact of prescription opioids on the health and safety of all Canadians.
The report, entitled Opioid Prescribing in Canada and its Potential Contribution to the Opioid Crisis, analyzes how Canadians are being prescribed opioids, the dosing of opioids compared to Canadian expert guidelines, and the use of opioids with other therapies. Reformulary Group leveraged its unique data set of public and private prescription claims data, to perform the analysis.
In Canada, 11 lives are lost each day due to opioids and 92 per cent of deaths are due to accidental opioid overdose.1 An average of 17 Canadians was hospitalized due to opioid poisoning each day in 2017. Opioid-related harms and deaths can be caused by both prescription or illicit opioids.
“The opioid crisis is a heartbreaking epidemic that doesn’t discriminate,” said Helen Stevenson, CEO of Reformulary Group. “People from all walks of life, all age groups and all socio-economic backgrounds are affected. Through this analysis, we hope to work with partners to develop innovative strategies and address the impact of prescription opioids on the health and safety of Canadians.”
Here are some of the top findings:
- Between one and five public plan claimants and one and six private plan claimants in Canada are being prescribed an opioid in a given year.
- Chronic opioid users account for ~21 per cent of all opioid users, and ~64 per cent of all opioid prescriptions.
- People aged 25 to 44, followed by those aged 45 to 64 use the highest doses of opioids – both age groups use well above the maximum dose recommended in the 2017 Canadian Guidelines for Opioids for Chronic Non-Cancer Pain the maximum 90 mg dose daily.
- Every year, people on lower doses continue to increase their dose. Approximately 10 per cent of patients each year are increasing above the 50 mg threshold and four per cent are increasing above 90 mg threshold.
- The 2017 Canadian Guidelines strongly discourage the use of opioids and benzodiazepines together. Benzodiazepines are a type of sedative commonly prescribed for anxiety or insomnia. These drugs are linked to a higher risk of opioid-related harm when taken with opioids. Nevertheless, one-in-six (16%) public plan claimants and one-in-10 (10%) private plan claimants taking chronic opioid therapy were also taking chronic benzodiazepine therapy.
“The prescribing of high-dose opioids (such as oxycodone, hydromorphone and fentanyl) for chronic pain is a dangerous practice that can easily harm patients, even when it seems to be helping,” said Dr. David Juurlink, head of the Clinical Pharmacology and Toxicology division at Sunnybrook Health Sciences Centre. “Unfortunately, countless patients have become trapped on high doses over the past two decades. New prescribing guidelines aim to help by promoting more judicious prescribing, including the avoidance of progressive dose escalation for patients starting opioid therapy and gradual tapering for those already on high doses.”
The link between opioid prescriptions and opioid-related deaths
A recently published study evaluated the link between opioid prescriptions and opioid-related deaths in Ontario between 2013 and 2016. There were 2,833 opioid-related deaths during the course of the study and approximately one-third of these people had an active opioid prescription on the date of their death.2
Opioid-related harm (e.g. some side effects, overdose, overdose-related deaths) are linked to the dosing of the opioids. By using morphine equivalent dosing (MED), Reformulary Group’s analysis was able to compare the relative dosing of the most commonly used opioids.
There were some positive signs with dose reduction among payers in the dataset. There was a decrease in the dose in the top 25 per cent of prescriptions from 2013 to 2017. However, a significant number of chronic opioid claimants are taking higher than the Guideline-recommended 90 mg dose daily.
By having clearly set goals at the start of therapy, healthcare professionals can consider tapering and stopping patients using opioids if they are not reaching their goals rather than continually increasing opioid doses.
“This new report from Reformulary Group demonstrates some areas of significant improvement for healthcare professionals and policymakers to address the crisis,” said Mike Boivin, clinical pharmacist and report contributor. “Although illicit opioids are likely the bulk of opioid-related harm in Canada, this report provides us with some definite opportunities where we can focus our resources to reduce the burden of prescription opioid use.”
For the full prescription opioid analysis, click here.