Too pop­u­lar a pre­scrip­tion

Re­port finds al­most 2 mil­lion On­tar­i­ans got opi­oids in a year

The Hamilton Spectator - - CANADA & WORLD - SH­ERYL UBELACKER

TORONTO — Al­most two mil­lion On­tar­i­ans — or 14 per cent of the prov­ince’s pop­u­la­tion — filled pre­scrip­tions for opi­oids in fis­cal year 2015-2016, says a new re­port, sug­gest­ing that pa­tients con­tin­ued to be given the po­tent nar­cotics de­spite ef­forts to cur­tail what’s been called a na­tional epi­demic of overuse.

The re­port by Health Qual­ity On­tario, re­leased Wed­nes­day, found that more than nine mil­lion pre­scrip­tions for the pow­er­ful painkillers were filled be­tween April 1, 2015, and March 31, 2016, the most re­cent fis­cal year for which data is avail­able. That fig­ure rep­re­sents an in­crease of 450,000 pre­scrip­tions over the same pe­riod three years ear­lier.

Not only did the num­ber of pre­scrip­tions spi­ral up­ward, but there was also a trend to­ward doc­tors choos­ing more po­tent ver­sions of the drugs, as well as a spike in the num­ber of pa­tients re­ceiv­ing the med­i­ca­tions, said Dr. Joshua Tep­per, pres­i­dent and CEO of the pro­vin­cial agency.

“De­spite peo­ple (be­ing) aware of the sig­nif­i­cant im­pact and dan­ger of opi­oids, we con­tinue to see a steady in­crease in the num­ber of pre­scrip­tions be­ing writ­ten,” said Tep­per.

The re­port found there had been a shift to doc­tors pre­scrib­ing stronger opi­oids over time. For in­stance, 29 per cent more pa­tients re­ceived hy­dro­mor­phone in 2015-16 than in 2013-14. The drug is five times more po­tent than mor­phine, the drug used in pre­scrib­ing guide­lines as a base­line stan­dard for com­par­ing the strengths of dif­fer­ent opi­oids.

“Hy­dro­mor­phone was a drug that a few years ago was very rarely used and now is be­ing much more com­monly pre­scribed,” he said. “You may see greater de­pen­dency over time de­vel­op­ing with lower-po­tency (drugs) and peo­ple shift­ing (to it) to deal with the tol­er­ance that de­vel­oped.”

Ad­dic­tion ex­perts say an­other rea­son doc­tors switched to such opi­oids as hy­dro­mor­phone, tra­madol and mor­phine re­lates to the re­place­ment of OxyCon­tin in 2012 with OxyNeo, a tam­per-proof ver­sion of the widely used drug that was sub­se­quently delisted from On­tario’s drug ben­e­fit for­mu­lary in a bid to curb ex­ces­sive pre­scrib­ing.

Tep­per said the re­port also looks at the age break­down of pa­tients re­ceiv­ing opi­oid ther­apy and the length of their treat­ment. For pa­tients aged 18 and younger, twothirds of pre­scrip­tions filled in early 2016 were for a short du­ra­tion, he said. “But what’s still strik­ing is that one-third of peo­ple zero to 18 are get­ting on­go­ing pre­scrip­tions, which is still quite sig­nif­i­cant.

“Then you move to peo­ple who are 45 to 64. Only 20 per cent of those peo­ple who are get­ting opi­oid pre­scrip­tions are get­ting just a one­time, short-term (course). That means 80 per cent are get­ting re­peat pre­scrip­tions.”

That ra­tio widens even more for peo­ple aged 65 and older: the data show only 15 per cent re­ceived a short-term course of opi­oids, while 85 per cent had on­go­ing treat­ment with the med­i­ca­tions.

“So to the de­gree that we un­der­stand there is a role for short-term opi­oids, that’s not typ­i­cally how we’re see­ing them pre­scribed,” said Tep­per. “That chronic­ity starts to lead into real is­sues of de­pen­dency.

“We’re not sure why we’re see­ing these pat­terns and I think that the hope of our re­port is that peo­ple will start to take a re­ally good look and try to un­der­stand within a given com­mu­nity what’s hap­pen­ing.”

While the re­port points to such mea­sures as greater ac­cess to the over­dose-re­ver­sal drug nalox­one and an in­creased em­pha­sis on pro­vid­ing treat­ment for opi­oid use dis­or­ders, the ma­jor driver of the opi­oid cri­sis — ram­pant over pre­scrib­ing — con­tin­ues.


The re­port by Health Qual­ity On­tario found there had been a shift to doc­tors pre­scrib­ing stronger opi­oids over the last few years.

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