Why doctors aim to curb ‘rampant prescribing of opioids’

Use of prescription opioids in Canada has risen steadily over the past 20 years, with skyrocketing misuse, disorders and deaths, say experts who call for enforceable guidelines and a national strategy to address overprescribing.

In Monday’s the Canadian Medical Association Journal, Prof. Benedikt Fischer of the Centre for Addiction and Mental Health in Toronto and his co-authors say it’s late, but not too late, for Canada to reduce the toll of opioid overuse and abuse. 

National surveillance data is spotty, but surveys suggest that by 2010, more than 1 in 20 adults and as many as 1 in 6 adolescents were using prescription opioids for non-medical purposes.

At the same time, demand for prescription opioid-related addiction treatment has soared.

In 2012, several provinces pulled oxycodone from their drug formularies and prescribing shifted to other potent opioids, such as fentanyl and hydromorphone. 

Fischer and his team seek guidelines to prescribe opioids only in exceptional cases, with strict limits on dose and duration.

They’d also like to see real-time electronic prescription monitoring systems across the country. They want doctors and pharmacists to be required to consult these databases before prescribing or dispensing opioids.

Here are some other key moments in Canada’s recent history of prescription opioids: 

Dispensing of opioid prescriptions starts to rise
Dispensing of prescription opoids in Canada increased from about 10,000 defined daily doses per million population a day in 2001-2003 to more than 30,000 in 2012-2014.
Drugmaker guilty of misleading public
Three executives with the U.S. branch of Purdue Pharma pleaded guilty in a U.S. Federal Court to misleading regulators and an unsuspecting public about risk of addiction to OxyContin.
National Opioid Use Guidelines introduced
Guidelines for safe and effective use of opioids include recommendations such as consider the use of a screening tool with little direction about when not to prescribe or limit doses.
Questions about oxycodone risk
Oxycodone was implicated in a disproportionate number of opioid-related harms and deaths, prompting several provinces to remove it from the drug formularies.
Prescribing shifts
Some provinces shift to prescribing other potent opioids, mainly fentanyl and hydromorphone.
National roadmap strategy
National strategy on reducing harms associated with prescription drugs presents vague recommendations, but it’s unclear how many have been effectively implemented, researchers say.
Draft federal regulations
Federal regulators present draft regulations to require a tamper-proof design for prescription oxycodone formulations that account for about 10 per cent of dispensed opioids.
U.S. guidelines introduced
U.S. Centers for Disease Control and Prevention recommends that doctors prescribe opioids at the lowest effective dosage possible only when the benefits from pain reduction and bodily function outweigh the risks.
British Columbia declares public health emergency over opioid deaths
 Opioid crisis that has killed more than 370 people in the province in the first part of 2016 is declared a public health emergency and a task force is created.
Nova Scotia crackdown
Nova Scotia College of Physicians and Surgeons endorses CDC guidelines and recommends doctors cut in half the amount of opioids they prescribe for chronic pain.

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