Open Access Research article

Trends and changes in prescription opioid analgesic dispensing in Canada 2005–2012: an update with a focus on recent interventions

Benedikt Fischer123*, Wayne Jones1 and Jürgen Rehm2345

  • * Corresponding author: Benedikt Fischer bfischer@sfu.ca

  • † Equal contributors

Author Affiliations

1 Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada

2 Social and Epidemiological Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada

3 Department of Psychiatry, University of Toronto, Toronto, Canada

4 Dalla Lana School of Population Health, University of Toronto, Toronto, Canada

5 Technische Universität, Dresden, Germany

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BMC Health Services Research 2014, 14:90  doi:10.1186/1472-6963-14-90

Published: 26 February 2014

Abstract

Background

Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. Canada features the world’s second-highest POA consumption rates. Following increases in POA-related harm, several POA control interventions have been implemented since 2010.

Methods

We examined trends and patterns in POA dispensing in Canada by province for 2005–2012, including a focus on the potential effects of interventions. Data on annual dispensing of individual POA formulations – categorized into ‘weak opioids’ and ‘strong opioids’ – from a representative sub-sample of 5,700 retail pharmacies across Canada (from IMS Brogan’s Compuscript) were converted into Defined Daily Doses (DDD), and examined intra- and inter-provincially as well as for Canada (total).

Results

Total POA dispensing – driven by strong opioids – increased across Canada until 2011; four provinces indicated decreases in strong opioid dispensing; seven provinces indicated decreases specifically in oxycodone dispensing, 2011–2012. The dispensing ratio weak/strong opioids decreased substantively. Major inter-provincial differences in POA dispensing levels and qualitative patterns of POA formulations dispensed persisted. Previous increasing trends in POA dispensing were reversed in select provinces 2011–2012, coinciding with POA-related interventions.

Conclusions

Further examinations regarding the sustained nature, drivers and consequences of the recent trend changes in POA dispensing – including possible ‘substitution effects’ for oxycodone reductions – are needed.

Keywords:
Prescription opioids; Oxycodone; Health policy; Canada; Population health