Local doctors prescribing more opioids

Study finds numbers top Ontario average — including one in five going to kids

The number of opioid prescriptions filled in the Hamilton area is well above the provincial average and climbing, reports Health Quality Ontario.

“That’s obviously concerning,” said Dr. Joshua Tepper, president and CEO of the organization that advises the provincial government on the quality of health care. “We talk a lot about the influence of street drugs and fentanyl from China. But the reality is we have a huge number of narcotics and opioids that start with the prescription pad.”

A report about the growing use of doctor-prescribed opioids in Ontario reveals almost 1.3 million prescriptions were filled between April 1, 2015 and March 31, 2016 in the Hamilton Niagara Haldimand Brant Local Health Integration Network, which includes Burlington.

That translates into 90 opioid prescriptions filled per 100 population.

It is up by seven per cent from two years earlier, when the rate was 86 per 100 people. It equates to 82,738 more prescriptions. It’s significant considering opioid addiction is a growing health crisis in Canada.

“The reality is after several years now of a high degree of discussion, we’re still seeing an overall trend not just of higher potency, which is in itself worrisome, but the overall numbers still being very significant and rising,” Tepper said.

To compare, Ontario had more than 9.1 million prescriptions filled, or 66 per 100 people.

Two years earlier, it was 8.7 million, or 64 per 100 people. The overall increase was five per cent.

“Our report highlights that things are getting worse not better on several fronts,” Tepper said. “In terms of the rate of prescriptions, not only has it gotten worse in the province, but it’s even worse in the Hamilton region.”

The prescriptions were filled by 214,341 people, or 15 per 100 population, in the Hamilton LHIN.

Ontario-wide it was more than 1.9 million patients, or 14 per 100 people.

In both cases, it translates into one in seven people filling a prescription for opioids. The data also suggest many get more than one prescription. “The data doesn’t allow us to answer the question of why,” Tepper said. “What I think it should do is encourage us to try to figure that out.”

Among the most concerning findings of the report is a shift away from codeine toward more potent opioids like hydromorphone in Ontario.

In the Hamilton area, hydromorphone prescriptions went up 32 per cent in two years, while codeine was down six per cent. The provincial average was the same.

Hydromorphone now accounts for one in four opioid prescriptions in the Hamilton area.

“One of the key findings of the report is more people receiving stronger-potency opioids, with more prescriptions going out,” Tepper said. “It’s a similar trend in Hamilton.”

Women are more likely to be prescribed opioids, making up 55 per cent of users. One in three opioid prescriptions went to those aged 1944, which was the highest overall percentage in the Hamilton LHIN.

But seniors are actually more likely to use opioids with 25 prescriptions per 100 population for those 65 and older. To compare, the number is 12 per 100 people for those aged 19-44.

One in five prescriptions went to children under the age of 18.

The data suggests one-third of children using opioids in Hamilton and Ontario-wide have been given multiple prescriptions, versus the more expected single short-term doses for this age group.

“There is still a role for opioids in some cases,” Tepper said about all ages. “We don’t want to create a complete zero-tolerance attitude and deprive a needed drug where it is appropriate. We’re just clearly not close to that range.”

However, Tepper warns improvements require resources and expertise to help health-care providers as well as those who are opioid-dependent manage a complex problem.

“As we work to do better, we really need to carefully taper patients,” he said. “We’ve got to be very careful not to trigger withdrawal and the suffering that comes with withdrawal. We need to help providers with the support, the guidance and the education.”