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Trends in high-dose opioid prescribing in Canada


Objective — The researchers sought to describe trends in high dose opioid prescribing rates and variations in opioid product selection across Canada.

Design — Population-based cross-sectional study.

Setting — Canada

Participants — Retail pharmacies dispensing opioids between January 1, 2006 and December 31, 2011.

Main Outcome Measure — Opioid dispensing rates, reported as the number of units dispensed per 1000 population, stratified by province and opioid type.

Results — The rate of high dose opioid dispensing increased 23.0%, from 781 units per 1,000 population in 2006 to 961 units per 1,000 population in 2011. Although these rates remained relatively stable in Alberta (6.3% increase) and British Columbia (8.4% increase), rates in Newfoundland and Labrador (84.7% increase) and Saskatchewan (54.0% increase) rose substantially. Ontario exhibited the highest annual rate of high dose oxycodone and fentanyl dispensing (756 tablets and 112 units per 1,000 population, respectively), while Alberta’s rate of high dose morphine dispensing was the highest in Canada (347 units per 1,000 population). Two of the highest rates of high dose hydromorphone dispensing were found in Saskatchewan and Nova Scotia (258 tablets and 369 tablets per 1,000 population, respectively). Conversely, Quebec had the lowest rate of high dose oxycodone and morphine dispensing (98 and 53 units per 1,000 population, respectively).

Conclusion — The researchers found marked inter-provincial variation in the dispensing of high dose opioids in Canada, emphasizing the need to understand the reasons for these differences, and to consider developing a national strategy to address opioid prescribing.



Gomes T, Mamdani M, Paterson M, Dhalla I, Juurlink D. Can Fam Physician. 2014; 60(9):826-32. Epub 2014 Sep 12.

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