(C-102) Trends in prescription opioid use for pain in Canada: a population-based repeated cross-sectional study

Background: The best available evidence on prescription opioid dispensing for pain in Canada has been limited to regional analyses in only parts of the country and national estimates using pharmaceutical sales data. Research is needed to address the dearth of information on population exposure to opioid analgesics and their variations by region, patient characteristics, and time across the country.

Objectives: We examined the 5-year incidence and prevalence trends of prescription opioid use for pain in Canada before and during the COVID-19 pandemic.

Methods: Our population-based repeated cross-sectional analysis of pharmacy dispensing data from six provinces (i.e., British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Québec) represented 93% of the Canadian population between January 1, 2018, and December 31, 2022. We calculated monthly population-adjusted rates per 1,000 population of new and prevalent users stratified by province and reported annual population-adjusted rates overall and stratified by age, sex, neighbourhood income quintile, and location of residence. We examined annual proportions of incident users receiving guideline-recommended maximum initial opioid doses and of prevalent users receiving the most common types of opioids (i.e., codeine, hydromorphone, oxycodone, morphine, and fentanyl).

Results: Monthly rates of incident and prevalent use of prescription opioids for pain declined across all provinces over time; however, the monthly rate of prevalent use was consistently highest in Manitoba and lowest in British Columbia. In 2022, we captured 1,818,680 incident and 2,770,268 prevalent users, with annual incidence ranging from 55.2 per 1,000 (Ontario) to 63.0 per 1,000 (Alberta) and annual prevalence ranging from 85.1 per 1,000 (Saskatchewan) and 96.3 per 1,000 (Alberta). Annual incidence and prevalence were consistently higher among females, older individuals, and people living in lower-income neighbourhoods and rural regions of Canada. New opioid recipients with a daily dose >50 milligrams of morphine equivalents (MME) varied provincially, but declined over time, with important shifts in the types of opioids prescribed.

Conclusions: We found a short-term decrease in incident opioid use for pain corresponding to the beginning of the COVID-19 pandemic and consistent declines in initiation and overall opioid dispensing across all provinces over time in line with national efforts to promote appropriate opioid prescribing for acute and chronic non-cancer pain across Canada.