Nearly a quarter of opioid prescriptions exceed guidelines

TORONTO — Nearly a quarter of first-time opioid prescriptions in Ontario from April 2015 to March 2016 exceeded new recommended dose limits.

Researchers say 23.9 per cent of initial opioid prescriptions in Ontario during that time had a daily dose of more than 50 milligram morphine equivalents. That’s more than the threshold set last year for physicians treating chronic non-cancer pain with opioids like oxycodone. The yearold guidelines suggest opioids be restricted to less than the equivalent of 90 milligrams of morphine per day, and ideally to less than 50 mg.

Researchers at the Institute for Clinical Evaluative Sciences and St. Michael’s Hospital examined initial opioid prescriptions for more than 650,000 Ontarians. Their work was published Wednesday in the journal Pain. Lead author Tara Gomes says the findings highlight the need to consider alternative pain management options for some patients, such as physiotherapy and cognitive behavioural therapy.

Dental pain accounted for nearly one in four new opioid prescriptions, but the study found these were generally low dose. One in six were for postsurgical pain, and more than 40 per cent of those patients were prescribed more than the equivalent of 50 mg of morphine daily. At least 25 per cent of prescriptions for hip and knee surgery were the equivalent of 90 mg of morphine daily, or more.