Rising dispensation of prescription opioids confirmed
Benedikt Fischer, 778.782.5148, firstname.lastname@example.org (Due to traveling until Monday best available by email)
Shazeeda Stettler, Fischer’s assistant, 778.782.5148, email@example.com
Carol Thorbes, PAMR, 778.782.3035, firstname.lastname@example.org
An investigative team led by Simon Fraser University health sciences professor Benedikt Fischer has established that starkly increasing prescription of strong opioids (POs) is driving up dispensation of the painkillers in Canada.
Fischer, also the CIHR/PHAC applied public health chair, notes POs are essential medication for treating severe and chronic pain. But, in recent years, they have been associated with strongly increasing morbidity (i.e., misuse and treatment admissions) and mortality (i.e., overdose deaths) in Canada.
The study, Differences and over-time changes in levels of prescription opioid analgesic dispensing from retail pharmacies in Canada, analyzes dispensing data for opioids-related prescriptions. It is based on a representative sample of 2,700 retail pharmacies in 10 provinces between 2005 and 2010. The Pharmacoepidemiology and Drug Safety Journal published the study’s results online in its July 2011 issue.
Based on an analysis of defined daily doses (DDD) of weak and strong POs per 1,000 people set by the World Health Organization (WHO), Canada’s dispensation of the drugs increased by 13.1 per cent. The amount of all dispensed POs rose from 20.3 DDD/1,000 people in 2005 to 23.0 DDD/1,000 people in 2010.
While the volume of dispensed strong POs rose by 42.1 per cent (7.6 to 10.8 DDD/1,000 people), the volume of weak ones dropped slightly by 4.4 per cent (12.7 to 12.2 DDD/1,000 people).
Based on WHO standards, the researchers defined strong POs as hydrocodone, hydromorophone, oxycodone, fentanyl, meperidine, methadone and morphine. The WHO defines codeine and its combination products as weak POs.
The research team included SFU adjunct professor Wayne Jones from the Centre for Applied Research in Mental Health and Addiction (CARMHA) and University of Toronto researchers Murray Krahn and Juergen Rehm.
North America has the highest POs-dispensation rate in the world and previous studies indicate increased dispensation of the painkillers is linked to increased POs-related illnesses and deaths. Governments are developing policy measures on how to reduce POs-related harms to public health. They include improved prescription monitoring and guidelines for opioids.
Given harm-related issues and that little is known about why POs dispensation is increasing, the study has a warning.
“Canada currently finds itself at a major policy and practice development juncture in regard to opioid use that, on the one hand, ought to maximize availability of opioid-supported care for chronic and severe pain with optimal standards and outcomes, while minimizing rapidly rising opioid-related problems and harms…
“The quantity and quality of opioids dispensed — different as these are between Canadian provincial jurisdictions — undoubtedly constitute a crucial variable in this challenge, yet key data are currently missing to guide decision making on the basis of evidence. This issue urgently requires further targeted investigation.”
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Backgrounder on new POs dispensation study
SFU professor Benedikt Fischer, adjunct professor Wayne Jones and their Toronto colleagues made two other key findings based on their study of the amount and type of opioids dispensed nationally. They also assessed the efficacy of opioids-related prescription monitoring programs (PMPs) in provinces where they existed.
The amount and type of POs dispensed varied significantly from province to province during the study period. At 32.4 DDD per 1,000 people, the dispensing rate was highest in Albert. It was the lowest in Quebec compared to other provinces at 9.6 DDD per 1,000.
While several provinces have opioid-related PMPs, dependable analysis of their efficacy is impossible because data collection for them is inconsistent and their implementation is not nationally standardized. From what the researchers could glean from available data, whether or not provinces had PMPs didn’t impact dispensation levels of prescription opioids.
- Two provinces virtually dominated dispensation of select strong opioids. Dispensation of oxycodone and hydrocodone was highest in Ontario. Dispensation of hydromorphone was highest in Nova Scotia.
- B.C.’s overall POs dispensing levels are among the highest in Canada, consisting mainly of weak opioids. Dispensing of strong opioids in the province is lower than in most other Canadian provinces, which may be a result of its PMP.
- All provinces showed increases in oxycodone dispensing rates over time.
- As in the U.S., Canada’s dispensation has more than doubled nationally in the last decade alone. Canada dispenses about half the amount of opioids prescribed in the U.S.
- Previous studies have noted that high school students, more than any other segment of the population, appear to be using prescribed opioids for non-medical purposes but there are no longitudinal studies to verify this. Non-medical refers to prescription drugs not prescribed by a doctor or not used for the purposes prescribed.