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

BMC Health Services Research

Jürgen Rehm¹  Wayne Jones²  Benedikt Fischer³ 

[1]Technische Universität, Dresden, Germany

[2]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, Toronto, Canada

关键词: Population health;    Canada;    Health policy;    Oxycodone;    Prescription opioids;   

Others  :  1134007
DOI  :  10.1186/1472-6963-14-90

 received in 2013-10-03, accepted in 2014-02-21,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Fischer et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 1.

【 参考文献 】

• [1]International Narcotics Control Board (INCB): Narcotic Drugs Technical Report: Estimated World Requirements for 2013 – Statistics for 2011. New York, NY: United Nations; 2013.
• [2]Brennan F, Carr DB, Cousins M: Pain management: a fundamental human right. Anesth Analg 2007, 105(1):205-221.
• [3]Lohman D, Schleifer R, Amon JJ: Access to pain treatment as a human right. BMC Med 2010, 8:8. BioMed Central Full Text
• [4]Fischer B, Argento E: Prescription opioid related misuse, harms, diversion and interventions in Canada: a review. Pain Physician 2012, 15(3 Suppl):ES191-ES203.
• [5]Fischer B, Keates A, Bühringer G, Reimer J, Rehm J: Prescription opioid misuse: Why so markedly higher in North America compared to the rest of the world? Addiction 2014, 109(2):177-181.
• [6]Galvez R: Variable use of opioid pharmacotherapy for chronic noncancer pain in Europe: causes and consequences. J Pain Palliat Care Pharmacother 2009, 23(4):346-356.
• [7]Seya M, Gelders S, Achara OU, Milani B, Scholten WK: A first comparison between the consumption of and the need for opioid analgesics at country, regional, and global levels. J Pain Palliat Care Pharmacother 2011, 25(1):6-18.
• [8]Van Zee A: The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health 2009, 99(2):221-227.
• [9]Fischer B, Ialomiteanu A, Boak A, Adlaf E, Rehm J, Mann R: Prevalence and Key covariates of non-medical prescription opioid Use among the general secondary student and adult populations in Ontario, Canada. Drug Alcohol Rev 2013, 32(3):276-287.
• [10]Fischer B, Nakamura N, Urbanoski K, Rush B, Rehm J: Correlations between population levels of prescription opioid use and prescription opioid-related substance use treatment admissions in the USA and Canada since 2001. Public Health 2012, 126(9):749-751.
• [11]Dhalla IA, Mamdani MM, Sivilotti ML, Kopp A, Qureshi O, Juurlink DN: Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ 2009, 181(12):891-896.
• [12]Office of the Chief Coroner of Ontario: Office of the Chief Coroner Report for 2009–2011. Toronto, ON: Ministry of Community Safety and Correctional Services; 2012.
• [13]Drug and Alcohol Treatment Information System (DATIS): Substance Abuse Statistical Tables: Fiscal Year 2007/2008 to Fiscal Year 2011/2012. Toronto, ON: Centre for Addiction & Mental Health; 2012.
• [14]Fischer B, Jones W, Rehm J: High correlations between levels of consumption and mortality related to strong prescription opioid analgesics in British Columbia and Ontario, 2005–2009. Pharmacoepidemiol Drug Saf 2013, 22(4):438-442.
• [15]Wisniewski AM, Purdy CH, Blondell RD: The epidemiologic association between opioid prescribing, non-medical use, and emergency department visits. J Addict Dis 2008, 27(1):1-11.
• [16]Dasgupta N, Kramer ED, Zalman MA, Carino S, Smith MY, Haddox JD, Wright C: Association between non-medical and prescriptive usage of opioids. Drug Alcohol Depend 2006, 82(2):135-142.
• [17]Dhalla IA, Mamdani MM, Gomes T, Juurlink DN: Clustering of opioid prescribing and opioid-related mortality among family physicians in Ontario. Can Fam Physician 2011, 57(3):e92-e96.
• [18]Fischer B, Jones W, Krahn M, Rehm J: Differences and over-time changes in levels of prescription opioid analgesic dispensing from retail pharmacies in Canada, 2005–2010. Pharmacoepidemiol Drug Saf 2011, 20(12):1269-1277.
• [19]Madadi P, Hildebrandt D, Lauwers AE, Koren G: Characteristics of opioid-users whose death was related to opioid-toxicity: a population-based study in Ontario, Canada. PLoS One 2013, 8(4):e60600.
• [20]Abuse A: Achieving a Balance: Tackling the Opioid Public Health Crisis. Toronto: College of Physicians and Surgeons of Ontario; 2010.
• [21]Canadian Guidelines for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Hamilton: National Opioid Use Guideline Group (NOUGG); 2010.
• [22]Silversides A: Inquest jury seeks to take prescription opioids off Ontario’s streets. BMJ 2011, 343:d4371.
• [23]Expert Working Group on Narcotic Addiction: The Way Forward: Stewardship for Prescription Narcotics in Ontario. Ontario: Ontario Ministry of Health and Long-Term Care; 2012.
• [24]Fischer B, Keates A: ‘Opioid drought’, Canadian-style? Potential implications of the ‘natural experiment’ of delisting oxycontin in Canada. Int J Drug Policy 2012, 23(6):495-497.
• [25]Weeks C: OxyContin delisting not the answer to opioid addiction, experts say. [http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/oxycontin-delisting-not-the-answer-to-opioid-addiction-experts-say/article548948/ webcite]
• [26]CBC: The Fifth Estate: Time bomb. [http://www.cbc.ca/player/Shows/Shows/the+fifth+estate/Season+37/ID/2237145419/ webcite]
• [27]Blackwell T: Canada’s deadly love affair with painkillers. [http://news.nationalpost.com/2011/11/14/canadas-deadly-love-affair-with-painkillers/ webcite]
• [28]Mehler-Paperny A: Ontario slow to act on prescription drug reforms, doctors charge. [http://www.theglobeandmail.com/life/health-and-fitness/ontario-slow-to-act-on-prescription-drug-reforms-doctors-charge/article547507/ webcite]
• [29]CTV: W5: Prescription for tragedy. [http://www.ctvnews.ca/w5/w5-producer-stephanie-kampf-undercover-1.994042 webcite]
• [30]Whelan E, Asbridge M, Haydt S: Representations of OxyContin in North American newspapers and medical journals. Pain Res Manag 2011, 16(4):252-258.
• [31]IMS Brogan (IMSB): IMSB Canadian compuscript audit. [http://www.imsbrogancapabilities.com/ webcite]
• [32]Canadian Compuscript. Montreal: IMS Brogan; 2013.
• [33]WHO Collaborating Centre for Drug Statistics Methodology: ATC/DDD index. [http://www.whocc.no/atc_ddd_index/ webcite]
• [34]WHO Collaborating Centre for Drug Statistics Methodology: Definition and general considerations. [http://www.whocc.no/ddd/definition_and_general_considera/ webcite]
• [35]World Health Organization (WHO): WHO’s Pain ladder. [http://www.who.int/cancer/palliative/painladder/en/ webcite]
• [36]Statistics Canada: Population by year, by province and territory. [http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo02a-eng.htm webcite]
• [37]Cherny NI, Baselga J, de Conno F, Radbruch L: Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative. Ann Oncol 2010, 21(3):615-626.
• [38]Potvin K, MacDonald K: Interprovincial variation in access to publicly funded pharmaceuticals: a review based on the WHO anatomical therapeutic chemical classification system. Can Pharm J 2004, 137(7):29-34.
• [39]Demers V, Melo M, Jackevicius C, Cox J, Kalavrouziotis D, Rinfret S, Humphries KH, Johansen H, Tu JV, Pilote L: Comparison of provincial prescription drug plans and the impact on patients’ annual drug expenditures. CMAJ 2008, 178(4):405-409.
• [40]Morgan SG, Raymond CB, Mooney D, Martin D: The Canadian Rx Atlas: 2nd edition. Vancouver, BC: University of British Columbia Centre for Health Services and Policy Research; 2008.
• [41]Ballantyne JC, Shin NS: Efficacy of opioids for chronic pain: a review of the evidence. Clin J Pain 2008, 24(6):469-478.
• [42]Trescot AM, Glaser SE, Hansen H, Benyamin R, Patel S, Manchikanti L: Effectiveness of opioids in the treatment of chronic non-cancer pain. Pain Physician 2008, 11(2 Suppl):S181-S200.
• [43]Lynch ME: The need for a Canadian pain strategy. Pain Res Manag 2011, 16(2):77-80.
• [44]Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006, 10(4):287-333.
• [45]Dasgupta N, Mandl KD, Brownstein JS: Breaking the news or fueling the epidemic? Temporal association between news media report volume and opioid-related mortality. PLoS One 2009, 4(11):e7758.
• [46]Fishman SM, Papazian JS, Gonzalez S, Riches PS, Gilson A: Regulating opioid prescribing through prescription monitoring programs: balancing drug diversion and treatment of pain. Pain Med 2004, 5(3):309-324.
• [47]Goldenbaum DM, Christopher M, Gallagher RM, Fishman S, Payne R, Joranson D, Edmondson D, McKee J, Thexton A: Physicians charged with opioid analgesic‒prescribing offenses. Pain Med 2008, 9(6):737-747.
• [48]Katz N, Panas L, Kim M, Audet AD, Bilansky A, Eadie J, Kreiner P, Paillard FC, Thomas C, Carrow G: Usefulness of prescription monitoring programs for surveillance–analysis of schedule II opioid prescription data in Massachusetts, 1996–2006. Pharmacoepidemiol Drug Saf 2010, 19(2):115-123.
• [49]Picard A: The Globe and Mail (Index-only). (Toronto): Globe & Mail; 2012:A.1. [The OxyContin switch: a lost battle in our war on pain]
• [50]Fishman SM: Commentary in response to Paulozzi et al.: prescription drug abuse and safe pain management. Pharmacoepidemiol Drug Saf 2006, 15(9):628-631.
• [51]Paulozzi L, Kilbourne EM, Desai HA: Prescription drug monitoring programs and death rates from drug overdose. Pain Med 2011, 12(5):747-754.
• [52]Gilson AM, Fishman SM, Wilsey BL, Casamalhuapa C, Baxi H: Time series analysis of California’s prescription monitoring program: impact on prescribing and multiple provider episodes. J Pain 2012, 13(2):103-111.
• [53]Gomes T, Juurlink DN, Moineddin R, Gozdyra P, Dhalla I, Paterson M, Mamdani MM: Geographical variation in opioid prescribing and opioid-related mortality in Ontario. Healthc Q 2011, 14(1):22-24.
• [54]Fischer B, Ialomiteanu A, Kurdyak P, Mann RE, Rehm J: Reductions in non-medical prescription opioid use among adults in Ontario, Canada: are recent policy interventions working? Subst Abuse Treat Prev Policy 2013, 8(1):4. BioMed Central Full Text
• [55]National Advisory Committee on Prescription Drug Misuse: First Do No Harm: Responding to Canada’s Prescription Drug Crisis. Ottawa, ON: Canadian Centre on Substance Abuse; 2013.