Behind the prescriptions:  a snapshot of opioid use across all Ontarians

Gomes, Tara; Pasricha, Sachin V.; Martins, Diana; Greaves, Simón; Tadrous, Mina; Bandola, Dana; Singh, Surinder; Paterson, Michael; Mamdani, M; Juurlink, David N.

doi:10.31027/odprn.2017.04

Cited by 20 publications

(25 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 A 2017 petition to the US Food and Drug Administration (FDA) called for banning opioid formulations that could achieve daily doses of 90 MME or more when taken as directed. 16 In Ontario, Canada, 40% of long-acting opioid prescriptions dispensed in 2016, a period immediately preceding the release of the new Canadian guidelines, were for daily doses exceeding 90 MME, 17 and approximately 4% of newly treated patients were initiated on a dose exceeding this threshold. 18 On January 31, 2017, Ontario's Public Drug Program (OPDP) delisted all high-strength opioid formulations that were listed on their formulary at the time, which included 75-and 100-mcg/h fentanyl patches, 24-and 30-mg hydromorphone capsules, and 200-mg morphine tablets.…”

Section: Introductionmentioning

confidence: 99%

Impact of delisting high‐strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada

Martins

Khuu²,

Tadrous

et al. 2019

Pharmacoepidemiology and Drug

Self Cite

View full text Add to dashboard Cite

Purpose High‐strength opioid formulations were delisted (removed) from Ontario's public drug formulary in January 2017, except for palliative patients. We evaluated the impact of this policy on opioid utilization and dosing. Methods We conducted a longitudinal study among patients receiving publicly funded, high‐strength opioids from August 2016 to July 2017. The primary outcome measure was weekly median daily opioid dose (in milligrams of morphine or equivalent; MME) of (1) publicly funded and (2) all opioid prescriptions irrespective of funding source, evaluated using interrupted time series analyses and stratified by palliative care status. Results Following policy implementation, the weekly median daily dose of publicly funded opioids decreased immediately among non‐palliative patients by 10 MME (95% confidence limit [CL], −16.8 to −3.1) from a pre‐intervention dose of 424.5 MME (95% CL, 417.8‐431.2) and fell gradually among palliative patients by 3.9 MME per week (95% CL, −5.5 to −2.3) from a pre‐intervention dose of 450.1 MME (95% CL, 432.5‐467.7). In contrast, among all opioid prescriptions, gradual reductions in weekly median daily doses were observed only for non‐palliative patients, which decreased by 0.7 MME per week (95% CL, −1.3 to −0.2) from a pre‐intervention dose of 426.2 MME (95% CL, 420.9‐431.5). Conclusion The delisting of publicly‐funded, high‐strength opioids was accompanied by changes in funding source and small reductions in the weekly median daily doses dispensed. Although observed dose reductions of less than 1 MME weekly are likely not clinically relevant, safety implications of these changes require further monitoring.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of delisting high‐strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada

Martins

Khuu²,

Tadrous

et al. 2019

Pharmacoepidemiology and Drug

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the majority of provinces, these deceleration trends for tramadol use rates remained stable post‐2012. This implies that tramadol does not seem to have acted as a more easily available (nonscheduled) “substitution” drug for—increasingly controlled and restricted—“strong opioids” in these contexts, contrary to what has been observed elsewhere (eg, increases in use of other “strong opioids” following oxycodone descheduling in Canada or hydrocodone use levels associated with schedule status changes in the United States) …”

Section: Discussionmentioning

confidence: 72%

“…This implies that tramadol does not seem to have acted as a more easily available (nonscheduled) "substitution" drug for-increasingly controlled and restricted-"strong opioids" in these contexts, contrary to what has been observed elsewhere (eg, increases in use of other "strong opioids" following oxycodone descheduling in Canada or hydrocodone use levels associated with schedule status changes in the United States). 12,16,17 The present study includes some limitations. The data used are based on community dispensing rates that represent the majority, but not the full extent (eg, not including hospital-based), of population-wide dispensing.…”

Section: Discussionmentioning

confidence: 94%

“…Concretely, there have been distinct—including interactive—dynamics related to opioids subject to changing or differential control (eg, scheduling) regimes. For example, the sudden delisting of slow‐release oxycodone formulations in Canadian provinces (2012) resulted in a “substitution” effect, ie, subsequent increases in the prescribing of alternative “strong opioids” (ie, hydromorphone and fentanyl) occurring in parallel to decreases in oxycodone dispensing and use . In the United States, hydrocodone formulations were long scheduled as “Schedule III” drugs in select states, associated with higher use levels compared with other “strong opioids”; these use levels substantially decreased following rescheduling to— the more restrictive—Schedule II status …”

Section: Introductionmentioning

confidence: 99%

“…For example, the sudden delisting of slow-release oxycodone formulations in Canadian provinces (2012) resulted in a "substitution" effect, ie, subsequent increases in the prescribing of alternative "strong opioids" (ie, hydromorphone and fentanyl) occurring in parallel to decreases in oxycodone dispensing and use. 12,16 In the United States, hydrocodone formulations were long scheduled as "Schedule III" drugs in select states, associated with higher use levels compared with other "strong opioids"; these use levels substantially decreased following rescheduling to-the more restrictive-Schedule II status. 17,18 Given high use levels of scheduled opioids, combined with recent interventions to curtail opioid dispensing and adverse consequences in Canada, along with the coinciding availability of tramadol as a "nonscheduled" prescription opioid, it was timely to examine tramadol dispensing trends and patterns, specifically as these relate to those of "strong opioids," in these contexts.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tramadol dispensing patterns and trends in Canada, 2007‐2016

Fischer

Kurdyak

Jones

2018

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

Purpose Opioid use and associated mortality and morbidity have substantially increased in Canada, which recent interventions have aimed to reduce. Tramadol is an atypical prescription‐only (but unscheduled under Canada's narcotics law) opioid analgesic and not subject to controls for other (eg, strong) opioids. Given experiences in different jurisdictions, tramadol may have been increasingly dispensed as a “substitute” drug during a period with increasingly restrictive controls for other (scheduled) opioids. Methods We examined the annual population‐level retail dispensing (as a proxy for use) of tramadol and (scheduled) “strong opioids” in Canadian provinces for 2007‐2016 based on data from a representative national sample of community pharmacies, covering the majority of episodes of opioid dispensing. Data for both aforementioned formulation categories were converted into defined daily doses (DDD)/1000 population/day and examined descriptively and by segmented regression analyses (to identify significant breakpoints in trends). Results Tramadol use strongly increased in all provinces until 2009. After 2009, tramadol dispensing levels either decelerated their increase or plateaued; “strong opioid” dispensing levels, in comparison, increased strongly until 2011 and decelerated or decreased for the remaining period. Tramadol was consistently dispensed at lower levels than “strong opioids.” Conclusions Tramadol and “strong opioids” showed similar (bifurcated) use trends, with initial increases and subsequent inflections, yet reductions in dispensing occurred earlier for tramadol than for “strong opioids” (the latter occurring following with recent interventions). Distinct from experiences with differential opioid control regimes elsewhere, there is no evidence that tramadol figured as a “substitution” drug for increasingly restricted “strong opioids” in Canada.

show abstract

Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain

et al. 2019

View full text Add to dashboard Cite

Key Points Question How can physicians identify patients with pain for whom prescription opioids can be safely prescribed? Findings This systematic review found that a history of opioid use disorder or other substance use disorder, a mental health diagnosis, and concomitant prescription of certain psychiatric medications may be associated with an increased risk of prescription opioid addiction. However, only the absence of a mood disorder appeared useful for identifying lower risk, and assessment tools incorporating combinations of patient characteristics and risk factors were not useful. Meaning This study suggests that there are few valid ways to identify patients who can be safely prescribed opioid analgesics.

show abstract

Behind the prescriptions: a snapshot of opioid use across all Ontarians

Cited by 20 publications

References 7 publications

Impact of delisting high‐strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada

Impact of delisting high‐strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada

Tramadol dispensing patterns and trends in Canada, 2007‐2016

Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain

Contact Info

Product

Resources

About