Lo­cal doc­tors pre­scrib­ing more opi­oids

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

The Hamilton Spectator - - FRONT PAGE - JOANNA FRKETICH

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.”

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