Opioid crisis study: nearly 1 in 4 in Ontario prescribed too much

Nearly one-quarter of those first prescribed opioids were told to take a dose that was higher than the maximum recommended by experts.

For the first time since an opioid epidemic started to sweep across Ontario, scientists have thrown back the curtain on how doctors prescribe that narcotic— and the results are concerning.

Nearly one-quarter of those first prescribed opioids were told to take a dose that was higher than the maximum recommended by experts, placing them at significantly greater risks for addiction, overdoses, motor-vehicle collisions and hip-fracturing falls, according to a study by researchers with a foremost expert on Ontario heath care, the Institute for Clinical Evaluative Sciences (ICES).

Dosing that exceeded maximum was even more common among those recovering from surgery to replace a knee or hip: Nearly two in three were prescribed more than the equivalent of 50 mg of morphine, the highest initial dose recommended by American experts in 2016 and Ontario experts last year for managing pain for all patients but those suffering from cancer.

“Improvements to safe opioid prescribing could be achieved by focusing on dose initiation patterns among surgeons.

The higher doses double the risk of overdose deaths and increase the chance of a motor-vehicle collision by between 20 per cent and 40 per cent, said Dr. Tara Gomes, lead author of the study and an epidemiologist at ICES

While people who die from opioid addictions are usually on those drugs for a long time, reducing the rate of addiction, in time, could reduce the death rate, Gomes said.

“We can avoid some of those deaths,” she told The Free Press.

It was not until 2012 that Ontario started tracking the practices of doctors prescribing opioids. Before then, the quality of prescription data was too poor to make meaningful findings, Gomes said.

Ontario first made new and better data available to scientists about a year and a half ago, she said, and that is what enabled the study, which will be published Wednesday in the journal Pain.

The study’s findings are based on a review of first-time opioid prescriptions for more than 650,000 Ontarians from April 1, 2015 to March 31, 2016.

Among the findings:

  • In a single year, doctors prescribed opioids to 1,957,552 people, all of whom but 19,024 had unique OHIP cards.
  • Nearly 60 per cent of those prescribed opioids had earlier prescriptions for that narcotic.
  • Doses that were too high weren’t the only concern; some doctors also prescribed opioids for longer than the recommended maximum duration of seven days.
  • Of those prescribed opioids, 151,874 (23 per cent) were managing dental pain but typically with smaller doses for short durations, 113,605 were recovering from surgery, 78,155 had more general musculoskeletal pain, nearly as many were recovering from trauma, while 42,832 – just 6.5 per cent — had pain associated with cancer or palliative care.
  • Doctors prescribed opioids more often for joint and muscle pain rather than back pain.

“Improvements to safe opioid prescribing could be achieved by focusing on dose initiation patterns among surgeons,” the study found.

The Canadian guidelines adopted last year are not binding as there may be some patients for whom the benefits outpace the risks for doses or durations that are longer than what the guidelines suggest, Gomes said. But those exceptions don’t explain an over-prescription rate of nearly one-quarter, she said.

Getting the word out about those guidelines has proven challenging because pain management cuts across so many different areas of medical practice, she said. Some doctors may be prescribing too much for too long because they aren’t up-to-date with last year’s guidelines, she said, a problem she hopes the study will correct.

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