Prescription opioid dispensing in Canada: an update on recent developments to 2018
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(2020) 13:68
SHORT REPORT
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Prescription opioid dispensing in Canada: an update on recent developments to 2018 Wayne Jones1, Lenka Vojtila2, Paul Kurdyak2,3,4 and Benedikt Fischer1,3,5,6*
Abstract Canada has been home to comparatively extreme developments in prescription opioid (PO) availability and related harms (e.g. morbidity, mortality) post-2000. Following persistent pan-Canadian increases in PO use, select control measures were implemented and PO dispensing levels—while only inconsistently by province—inverted, and began to plateau or decrease post-2012. We examined annual PO dispensing levels in Canada up until 2018, based on representative prescription sample data from community-based retail pharmacies. Annual prescription-based dispensing data were converted into defined daily doses/1000 population/day by province, and mainly categorized into ‘weak’ and ‘strong’ opioids. All provinces indicated decreasing trends in strong PO levels in most recent years, yet with inter-provincial differences of up to one magnitude in 2018; in about half the provinces, dispensing fell to below-2005 levels. British Columbia had the largest decline in strong PO dispensing from its peak rate (− 48.5%) in 2011. Weak opioid dispensing trends remained more inconsistent and bifurcated across Canada. The distinct effects of individual—including many provincially initiated and governed—PO control measures urgently need to be evaluated. In the meantime, recent reductions in general PO availability across Canada appear to have contributed to shortages in opioid supply for existent, sizable (including non-medical) user populations and may have contributed to recent marked increases in illicit opioid use and harms (including rising deaths). Keywords: Canada, Dispensing, Interventions, Opioids, Public health
Introduction In North America, the epidemiological picture of high availability and use of prescription opioids (POs), and related public health consequences, are well-documented [1– 4]. Post-2000, PO dispensing began to rise rapidly, resulting in the USA and Canada becoming the world's two countries with the highest PO use rates [5]. In parallel, key POrelated adverse consequences—including increases in nonmedical use, morbidity (e.g. hospitalizations) and mortality (e.g. fatal poisonings)—unfolded, leading to a PO-related ‘public health crisis’ including unprecedented reductions in life expectancy [1, 3, 6]. Most of the above population-level
* Correspondence: [email protected] 1 Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada 3 Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada Full list of author information is available at the end of the article
morbidity and mortality outcomes have been shown to be strongly correlated with PO dispensing volumes [7–9]. North American governments and regulators began to more actively implement measures to address increasing PO-related harm
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