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.

Read more news of London on our site.

If you notice an error, highlight the text you want and press Ctrl + Enter to report it to the editor
2 views in october
I recommend
No recommendations yet


Post your comment to communicate and discuss this article.

London area home sales fell 15.9 per cent in September from August because of a shortage of homes to sell, and that shortage of inventory helped push up prices by 20 per cent from a year ago, the head of the London St. Thomas Association of Realtors (LSTAR) said. In September, LSTAR reported 776 homes changed hands in London and St. Thomas, compared to a near-record August, when 923 homes were sold. By the numbers Homes sold in September: 776 (a drop of 6....
Radical preacher Anjem Choudary, jailed for inviting support for the Islamic State group, has been released. The cleric was sentenced in 2016 to five-and-a-half years in prison. He led an extremist network linked to violent jihadists, including one of the killers of soldier Lee Rigby in 2013. Choudary, 51, has now served half of his sentence and will complete the rest under strict supervision. Police are preparing up to 25 measures to control him, the BBC...
One of London's front-running mayoral candidates has already put 40 per cent more of his own money into his campaign than the $25,000 limit allowed by law, a move that could put him in jeopardy if he wins the top job, provincial and civic election officials say. One of London’s front-running mayoral candidates has already put 40 per cent more of his own money into his campaign than the $25,000 limit allowed by law, a move that could put him in jeopardy if...
Nearly 150 County of Lambton paramedics are no longer responding to non-emergency calls amid ongoing negotiations for a new contract. Job action as of last Saturday means Lambton County paramedics won’t be doing non-urgent transfers between hospitals for the next while, or keeping ambulance stations as neat and tidy, a union spokesperson says. Nearly 150 Lambton Emergency Medical Services (EMS) paramedics represented by SEIU Healthcare Local 1 stopped resp...
Clapham Junction has been named London’s worst mainline train station for disruption in a survey by leading consumer title Which? Fifty-seven per cent of trains have been late or cancelled at the south London interchange since the beginning of the year, their research found. Their study found King’s Cross was the second worst, with 51 per cent of trains delayed or cancelled, followed by Victoria (47 per cent), Stratford (44 per cent) and London Bridge (44...
Tube drivers on the Piccadilly Line are set to hold fresh 24-hour strike action in a row over staffing and working conditions. The RMT Union has urged members to walk out at 12:00 BST on 7 November until noon the following day - writes bbc.com The union's general secretary Mick Cash said it had become "frustrated" with Tube bosses' handling of a "full raft of issues". Transport for London (TfL) said it was "disappointed" with the new strike. Drivers on the...
The Tate and the Royal Shakespeare Company (RSC) are calling for a premium to fund arts classes in England's schools. The major arts institutions say league tables and pressures on time and budgets are squeezing out important creative subjects - writes bbc.com Six thousand 11 to 18-year-olds have described how the subjects help build their confidence, in new research. The government says it is investing almost £500m in arts and music. Creative subjects hav...
Five teenagers have been jailed for fatally stabbing a man in an unprovoked attack as he returned home from an appointment with his pregnant partner. Daniel Frederick, 34, was knifed repeatedly by the group just yards from his home in Stoke Newington, Hackney. Three teenagers were convicted of murdering Mr Frederick while another two were found guilty of manslaughter. They were jailed at the Old Bailey for a combined total of at least 64 years. Judge Phili...
Work at a building site near London's Olympic Park has stopped after complaints about "horrendous" smells. Nearby Mossbourne Academy said its students felt sick and local residents spoke of headaches because of smells coming from the site in Hackney Wick. The London Legacy Development Corporation (LLDC) told Telford Homes to stop work last month until a new plan to "manage the site" was approved. The LLDC and Telford Homes claimed there was no health risk....