Nearly a quarter of Ontarians newly prescribed opioids received dose exceeding guidelines

May 16, 2018, St. Michael's Hospital
Dr. Tara Gomes and her team have found that nearly a quarter of all Ontarians newly prescribed opioids received a daily dose exceeding clinical guideline. Credit: St. Michael's Hospital

Nearly a quarter (23.9 per cent) of initial opioid prescriptions in Ontario had a daily dose of more than 50 milligram morphine equivalents (MME), exceeding the suggested dose threshold for opioid prescriptions outlined in North American clinical guidelines, according to a new study from the Institute for Clinical Evaluative Sciences (ICES) and St. Michael's Hospital.

"The U.S. and Canadian clinical guidelines for prescribing opioids for chronic non-cancer suggest that doctors should avoid initiating opioids at daily doses above 50 MME. Our study found that nearly one-quarter of Ontarians taking an for the first time received a daily dose exceeding this threshold, and for certain indications such as knee, hip and shoulder surgeries and Caesarean sections, the dose was even higher," says Dr. Tara Gomes, lead author of the study and a scientist at ICES.

The study, published today in the journal Pain, examined initial opioid prescriptions for more than 650,000 Ontarians from April 2015 to March 2016 and linked each to health administrative data from Ontario's publicly funded health care system.

"Due to concerns about the overprescription of opioids, there is an ongoing need to determine how to resource alternative non-pharmaceutical pain management strategies . In order to do this, we wanted to get a clear picture of the clinical indications associated with opioid initiation and the characteristics of those initial prescriptions," adds Gomes, who is also a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital.

Prescriptions for opioids have increased sharply in the last decade, making Canada the second highest per-capita user of opioids in the world. Furthermore, 1 in 8 Ontarians was dispensed an opioid in 2016, and Ontario has seen a four-fold increase in overdose deaths in the last 25 years, according to earlier research by Gomes.

The researchers grouped the reasons for starting opioids into six clusters: (23.2 per cent of prescriptions), postsurgical pain (17.4 per cent), musculoskeletal pain (12.0 per cent), trauma-related pain (11.2 per cent), cancer or palliative care (6.5 per cent), and other types of pain (17.7 per cent). Overall, 78,481 (12.0 per cent) of individuals could not be linked to any of the six indications).

The study showed that the dose and duration of initial opioid prescriptions varied considerably by indication. Dental pain accounted for nearly one in four new opioid prescriptions, but these were generally of short duration and low dose. In contrast, one in six new opioid prescriptions were for postsurgical pain, and these patients generally started on higher daily doses (over 40 per cent of them were prescribed more than 50 MME, and for hip and knee surgery at least 25 per cent were prescribed 90 MME or more).

"We know that patients' first opioid are critically important. Across all clinical indications, a high percentage of people received daily doses of more than 50MME and prescription lengths exceeding seven days, a combination which has been associated with opioid-related adverse events and long-term opioid use. Given this, we need to think about alternative pain management options. This data can help us understand the types of services—like physiotherapy and cognitive behavioural therapy—that might be appropriate to help avoid our reliance on opioids for some indications," says Gomes.

Explore further: New data: Americans filling far fewer opioid prescriptions

More information: "Clinical indications associated with opioid initiation for pain management in Ontario, Canada: A population-based cohort study," was published in the current issue of Pain.

Related Stories

New data: Americans filling far fewer opioid prescriptions

April 19, 2018
The number of prescriptions for opioid painkillers filled in the U.S. fell dramatically last year, showing their biggest drop in 25 years and continuing a decline amid increasing legal restrictions and public awareness of ...

One in every six deaths in young adults is opioid-related: study

April 25, 2018
One out of every six deaths among young adults in Ontario is related to opioids, suggests a study led by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES).

Dentist group puts teeth in push to curb opioid painkillers

March 26, 2018
The American Dental Association wants dentists to drastically cut back on prescribing opioid painkillers.

New report finds growing number of people in Ontario treated for opioid addiction

August 22, 2017
The rate at which people are being prescribed opioids to treat pain in Ontario has stabilized while the amount of drugs they receive has declined considerably, a new report has found. However, nearly 40 per cent of long-acting ...

Effect of an opioid prescribing protocol on provider prescribing behavior

March 23, 2018
At the 47th Annual Meeting of the American Association for Dental Research (AADR), held in conjunction with the 42nd Annual Meeting of the Canadian Association for Dental Research (CADR), Chad Lowell Wagner, University of ...

Patients who get opioids in the ER are less likely to use them long-term

September 26, 2017
Compared to other medical settings, emergency patients who are prescribed opioids for the first time in the emergency department are less likely to become long-term users and more likely to be prescribed these powerful painkillers ...

Recommended for you

Medicating distress: Risky sedative prescriptions for older adults vary widely

October 18, 2018
Despite years of warnings that older adults shouldn't take sedative drugs that put them at risk of injury and death, a new study reveals how many primary care doctors are still prescribing them, how often, and exactly where.

Medical management of opioid-induced constipation differs from other forms of condition

October 17, 2018
Traditional laxatives are recommended as first-line agents to treat patients with a confirmed diagnosis of opioid-induced constipation (OIC), according to a new guideline from the American Gastroenterological Association ...

Research assesses geographic distribution of new antibiotics following market introduction

October 16, 2018
There is a growing need for new antibiotics to help combat the looming threat of antimicrobial resistance. According to a new study conducted by researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) with ...

Health insurer policies may discourage use of non-opioid alternatives for lower back pain

October 5, 2018
Public and private health insurance policies in the U.S. are missing important opportunities to encourage the use of physical therapy, psychological counseling and other non-drug alternatives to opioid medication for treating ...

Opioid overdoses, depression linked

October 3, 2018
The link between mental health disorders and substance abuse is well-documented. Nearly one in 12 adults in the U.S is depressed, and opioid-related deaths are skyrocketing. As these numbers continue to climb, some mental ...

Do price spikes on some generic drugs indicate problems in the market?

October 1, 2018
A new USC study reports that sudden price spikes for some generic drugs—such as the recently reported increases of a decades-old generic heart medication and an antibiotic—are becoming more common.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.