Saskatchewan Federation of Police Officers 75 Between 2012 and 2016, the total number of defined daily doses of opioids dispensed in Canada declined from 238 million to 226 million.When adjusted for population growth, the rate per 1,000 people decreased by 8.9% during this period. “The good news is that the overall quantity of opioids dispensed in Canada is declining, but the fact that such a large number of people are still being prescribed opioids continues to be a concern,” says Michael Gaucher, director of Pharmaceuticals and Health Workforce Information Services at CIHI. In 2016, 21.5 million prescriptions for opioids were dispensed in Canada up from 20.2 million in 2012. “Opioids are very effective drugs and they’re an important part of pain management for many Canadians, but the benefits and risks need to be considered when being prescribed.” This increase is just over 2% when adjusted for population growth. During this period, an increasing proportion of all opioid prescriptions in Canada were for strong opioids, up from 52.2% in 2012 to 57.3% in 2016. 6 opioids accounted for more than 96% of all opioid prescriptions: hydromorphone, morphine, fentanyl, oxycodone, codeine and tramadol. The first 4 of these 6 are considered strong opioids and are usually prescribed for moderate to severe pain. “We have to acknowledge that this is a balancing act.While we’re trying to reduce the prescribing of opioids overall, we have to recognize that there are people who, for a very significant period of time, have been dependent on strong opioids.We’re not going to change that overnight.” Although a great deal of attention has focused on fentanyl and the harms attributed to its use and misuse, it is much less frequently prescribed than other strong opioids. Since 2012, the number of prescriptions for strong opioid prescriptions other than fentanyl has increased more than 19%, while the number of fentanyl prescriptions has decreased by almost 7%. “I think this shows that the fentanyl reportedly being used by Canadians is more likely coming from illicit sources rather than from prescriptions.” Seniors had the highest rates of opioid prescriptions in Canada between 2012 and 2016, with more than 200 in 1,000 seniors receiving at least one in 2015–2016.The data also shows that 1 in 8 seniors prescribed an opioid were prescribed a strong opioid on a chronic basis. Seniors are at greater risk for opioid-related harms due to several factors, including age-related changes in drug absorption and metabolism, and cognitive changes that may increase the risk of accidental drug poisoning. British Columbia and Quebec had the lowest number of defined daily doses per 1,000 people, at 5,496 and 3,601, respectively, while Alberta and Newfoundland and Labrador had the highest, at 7,955 and 7,878, respectively. The overall Canadian average was 6,110 defined daily doses per 1,000 people. “This new report rightly points out that we need to look at Quebec in much more detail and try to figure out why it’s so different from the rest of the country with regard to opioid prescribing,” says Strang. Both B.C. and Nova Scotia adopted new opioid prescribing guidelines in 2015, and they both also experienced the most substantial decreases in opioid dispensing between 2015 and 2016, with defined daily doses per 1,000 population declining by 11.7% in B.C. and by 6% in Nova Scotia. “When you look at the overall decreases across the country, particularly in B.C. and Nova Scotia, over the past year, changes in policy and increased awareness of the potential dangers of opioids seem to be making an impact,” says Gaucher. www.cihi.ca OPIOIDS IN CANADA continued
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