Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis

Gomes, Tara; Mastorakos, Andrea; Paterson, J. Michael; Sketris, Ingrid S.; Caetano, Patrícia; Greaves, Simón; Henry, David

doi:10.9778/cmajo.20170104

Cited by 26 publications

(27 citation statements)

References 15 publications

(9 reference statements)

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“…This trend continued until 2012, when OxyContin was reformulated in Canada and replaced by a tamper-resistant formulation (OxyNEO). Although OxyContin had previously been listed on provincial formularies across Canada, most provinces opted for more restrictive reimbursement of OxyNEO, resulting in shifts in the types of opioids dispensed to patients eligible for public drug benefits (Gomes et al 2017b). Furthermore, although generic forms of long-acting oxycodone were eventually approved by Health Canada (Miller 2013), these forms were not listed on most public drug plans because they were not tamper-deterrent, and there was concern that the long-acting properties of these Understanding the Implications of a Shifting Opioid Landscape in Ontario ICES Report Tara Gomes and David N. Juurlink products could be circumvented by crushing them, releasing all their contents at once.…”

Section: Changing Patterns Of Opioid Prescribing In Ontariomentioning

confidence: 99%

“…As long-acting oxycodone became less accessible, two key changes were observed in opioid prescribing patterns. First, overall prescribing of long-acting opioids declined by 23% in Ontario (from 50,865 to 39,288 milligrams of morphine or equivalent [MME] per 1,000 population) between February 2012 and April 2016 (Gomes et al 2017b), and a 22% reduction was observed in the annual rate of long-acting opioid recipients between 2013 and 2018 (from 14.1 to 10.9 recipients per 1,000 population; Figure 1). Second, prescribing shifted to strong opioids with fewer reimbursement constraints.…”

Section: Changing Patterns Of Opioid Prescribing In Ontariomentioning

confidence: 99%

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Understanding the Implications of a Shifting Opioid Landscape in Ontario

Gomes¹,

Juurlink²

2019

hcq

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North America is currently in the midst of an opioid overdose crisis, leading to changes in drug policy and clinical practice guideline recommendations. Data from Ontario's prescription monitoring program and the Office of the Chief Coroner for Ontario can be used to characterize changing prescription opioid trends and their role in fatal opioid overdoses. A better understanding of historical patterns of opioid use and overdose can help inform a more nuanced drug policy in the future.

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Section: Changing Patterns Of Opioid Prescribing In Ontariomentioning

confidence: 99%

Section: Changing Patterns Of Opioid Prescribing In Ontariomentioning

confidence: 99%

Understanding the Implications of a Shifting Opioid Landscape in Ontario

Gomes¹,

Juurlink²

2019

hcq

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“…31 The observed increasing preference for hydromorphone and the decrease in oxycodone prescribing are also in keeping with trends across Ontario more broadly after drug reimbursement changes were put in place, in 2012, to address Research the misuse of controlled-release oxycodone. 22 The preference for hydromorphone may reflect its enhanced tolerability in those with renal impairment and potential to be prescribed in smaller dosages to mitigate side effects. At present, it is difficult to estimate the impact of policy changes designed to address the wider crisis of nonmedical opioid use and opioidrelated adverse events in the community on opioid prescribing in long-term care.…”

Section: Discussionmentioning

confidence: 99%

“…We derived the combined total daily dosage in MME using established conversion ratios (Supplementary Table S3, Appendix 1). 22 Measures captured at each assessment date included the proportion of residents prescribed any opioid and the proportion who received specific opioid agents (codeine, hydromorphone, morphine, fentanyl and oxycodone), different formulations (long-acting and short-acting), a total daily dosage greater than 90 MME and opioids coprescribed with benzodiazepines.…”

Section: Medication Usementioning

confidence: 99%

Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study

Iaboni

Campitelli

Bronskill

et al. 2019

cmajo

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Background: Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. Methods: We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. Results: Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). Interpretation: Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes.

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“…For example, a large U.S. surveillance study found that, after the introduction of oxycodone OP, abuse rates for buprenorphine and oxymorphone ER increased significantly; among those who only inject prescription opioids, the rates of buprenorphine and morphine ER abuse also increased significantly during the same period . Thus, the benefits of ADFs may be limited, while nondeterrent alternatives are easy to obtain …”

Section: Potential For Abuse‐deterrent Formulations To Reduce the Rismentioning

confidence: 99%

Mitigation of IV Abuse Through the Use of Abuse‐Deterrent Opioid Formulations: An Overview of Current Technologies

Rauck

2019

Pain Practice

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Providers who treat patients with chronic pain face a dual challenge: providing adequate access to opioid therapies for appropriate pain management while adopting strategies to minimize the risk for abuse. Commonly prescribed opioids have substantial abuse potential when administered intravenously, and extended‐release (ER)/long‐acting (LA) opioids may be targeted for intravenous (IV) abuse because of the higher per‐dose medication level. The consequences of IV opioid abuse are severe and increase the risks for adverse outcomes, including mortality due to acute health events, serious infections, and deep vein thrombosis, to name a few. To reduce the potential for abuse of prescription opioids by both recreational and experienced drug abusers, abuse‐deterrent formulations (ADFs) of opioid medications employ either physical/chemical barriers or agonist‐antagonist combinations. Here we review the development and use of opioid ADFs as a harm‐reduction strategy, and their potential for mitigating IV opioid abuse. The approved ER/LA opioids with ADF labeling in the United States include formulations of oxycodone, hydrocodone, and morphine. Findings from in vitro laboratory tests of abuse deterrence for opioid ADFs are described herein, as are data from human abuse potential studies for IV abuse of those ADF products, for which such studies are feasible (ie, abuse‐deterrent agonist‐antagonist formulations). The available ADF opioids may decrease both the attractiveness and the feasibility of IV abuse. The adoption of ADF opioids represents one tactic for providing access to needed medication for patients with chronic pain, while potentially reducing the risk for opioid abuse, in a comprehensive effort to combat the opioid epidemic.

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Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis

Cited by 26 publications

References 15 publications

Understanding the Implications of a Shifting Opioid Landscape in Ontario

Understanding the Implications of a Shifting Opioid Landscape in Ontario

Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study

Mitigation of IV Abuse Through the Use of Abuse‐Deterrent Opioid Formulations: An Overview of Current Technologies

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