Newly started primary care opioid prescriptions plateaued in 2018-2019

Our new study published in the Canadian Journal of Addiction found plateauing rates of new starts of opioid analgesics in British Columbia in 2018-2019. We wanted to find out how many and what kind of opioid prescriptions were started to opioid naïve patients by family physicians in British Columbia.

QUICK FACT:

Current evidence suggests that the rate of opioid analgesic initiations in primary care remained unchanged in 2018-2019.

How was the study done?

We looked at all new starts of opioid analgesics to opioid naïve persons in 2018-2019 in the centralized medication management database PharmaNet. We defined opioid naïveté as being currently off opioids in the last 6 months, or never prescribed opioids.

  • We selected 5,657 doctors (87% of all practicing family physicians) from the PharmaNet database.
  • We only selected family physicians who were (1) currently treating patients (defined as having written at least 25 prescriptions, for any drug, in preceding 12 months); and (2) who prescribed at least one opioid during 2018-2019.
  • We also looked at the doctors’ age, year of graduation, and geographical location.

What did the study find?

We found that Between December 1st, 2018 and November 30th, 2019, there were 139,145 opioid starts to opioid naïve patients. An average physician started 2.05 new prescriptions per month. Most new starts were:

  • in the Lower Mainland regions of BC, also where the population is most concentrated (33% in the Fraser region),
  • by prescribers who graduated between 1986-1995 (28%), and
  • by prescribers who had less than 10 patient visits per day (52%).

An ongoing study addresses the effectiveness of a randomized controlled trial to evaluate a designated family physician intervention using BC’s centralized prescription database to reduce new starts of opioid analgesics in primary care.

Why are new starts of opioid analgesics important?

British Columbia is amid a public-health crisis, with more than six deaths a day due to drug poisoning. The receipt of chronic prescription opioid treatment for non-cancer pain has also the potential to transition to illicit opioid and intravenous drug use, substantially increasing the risk for overdose and blood-borne infections. Rates of poisoning death due to counterfeit fentanyl have also risen and represent a growing crisis in most regions in Canada, with British Columbia (BC) accounting for one-third of Canada’s poisoning deaths. In the first 10 months of 2021, the province had already had 1,782 illicit-drug deaths and had surpassed the total for all of 2020.

First published on Linked In.

Reference: Klimas, J., Hamilton, M.-A., Carney, G., Cooper, I. R., Croteau, N. S., Dong, H., Dormuth, C., Maclure, M., Socías, M. E., Ti, L., Wood, E., & McCracken, R. (2022). Characteristics and Incidence of Opioid Analgesic Initiations to Opioid Naïve Patients in a Canadian Primary Care Setting. Canadian Journal of Addiction, 13(1):43-50. https://doi.org/10.1097/CXA.0000000000000135

Disclaimer. All inferences, opinions, and conclusions are those of the authors, and do not reflect the opinions or policies of the Data Steward. The BC Ministry of Health and the BC Vital Statistics Agency approved access to and use of BC data for this paper.

British Columbia data sources were as follows: BC Ministry of Health [creator] (2019): PharmaNet. BC Ministry of Health [publisher]. Data Extract. Data Stewardship Committee (2017). http://www2.gov.bc.ca/gov/content/health/conducting-health-research-evaluation/data-access-health-data-central

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