Overall opioid volume down in Ontario, but many still getting too much

Ontario doctors appear to be prescribing lower amounts of opioids overall to treat patients with pain, say researchers, but many longtime users continue to be given daily doses of the potent narcotics that exceed national practice guidelines.

A report by the Ontario Drug Policy Research Network found the number of people prescribed an opioid remained relatively constant over the past five years, with 1.95 million, or one in seven Ontarians, treated with the potentially addictive medications last year.

However, the overall volume of opioids dispensed fell by 18 per cent between January 2015 and March 2017, driven by a reduction in the amount of long-acting, slow-release formulations - such as fentanyl patches and some types of oxycodone - prescribed to patients.

Still, researchers found that nearly 40 per cent of long-acting opioid prescriptions dispensed to people already using the drugs for pain had daily doses that surpassed the recommended threshold under 2017 Canadian prescription guidelines for opioid use in chronic non-cancer pain.

A panel of experts who penned the guidelines said opioids like oxycodone, hydromorphone and the fentanyl patch should be prescribed at a daily dose of less than the equivalent of 90 milligrams of morphine, and ideally less than 50 mg.

Gomes said the number of patients exceeding that dose as suggested by prescription data is likely even higher because long-term opioid users often are treated with both long-acting and immediate-release opioids.

In 2016, the report found almost 12 per cent of Ontarians were prescribed an opioid for all types of pain; 2.3 per cent for mostly seasonal cough suppression; and 0.4 per cent for opioid addiction.

Although 0.4 per cent may seem like an insignificant number, Gomes said that figure represents one in every 243 people in the province getting help for an opioid addiction - and that only accounts for those who have sought treatment.