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Fewer people prescribed opioids, but data are needed for all provinces: doctor

VANCOUVER – Fewer people in British Columbia, Saskatchewan and Ontario received opioids last year compared to 2013, and the number of patients who started treatment with pain medication has declined by nearly 10 percent, the Canadian Institute for Health Information said.

The institute said in a report released Thursday that eight percent fewer patients, or about 220,000 people, in these provinces are taking opioids, while approximately 175,000 fewer people have started using the drugs.

Patients who started taking opioids received lower doses for a shorter period, and when it came to long-term opioid therapy, fewer people received the medication for a period of 90 days or more before switching to other types of opioid drugs. control the pain, the agency said.

He said initiatives including national prescribing guidelines introduced in 2017, along with prescription monitoring programs to help reduce the damage related to the overdose crisis, probably influenced prescribing trends.

"Despite declining overall trends in opioid prescribing, opioid-related injuries and deaths have continued to increase nationwide in recent years," the report says.

Michael Gaucher, the agency's director of pharmaceuticals, said only the three provinces provided complete opioid prescribing data for the six years covered in the report, but they represent a large portion of Canada's population.

Some chronic pain patients have been concerned about eliminating the opioids they need, and Gaucher said this is a valid issue to consider because opioids are an effective treatment.

"Concern about prescribed opioids goes deeper than the person (taking them) and there may be others in the family who can access them," he said.

Norman Buckley, scientific director of the Michael G. DeGroote Institute for Pain Research and Treatment at McMaster University, said it was "unfortunate" that data from Quebec and Alberta, for example, could not be included in the report.

He said doctors in Quebec generally prescribe fewer opioids than other provinces and are known to receive a substantial amount of pain management education, while doctors in Alberta and BC have access to real-time prescription monitoring systems for the patients.

"You could argue that having a combined pain strategy actually also leads to less opioid dependence," he said of Hamilton.

Buckley, who often treats pain patients referred to him by other doctors, said it is important for patients to know that they need to gradually lower opioids.

"It's the right or the right prescription rather than trying to lower the dose. What you need to look at is things like function measurements, and these don't usually show up on large-scale health administrative data," he said.

"Can't you say that if people's doses dropped, they stopped going to work, for example, or started to get more home care assistance?"

Buckley said one of his patients, a man in his late fifties, received opioids for 10 years due to a variety of workplace injuries, but decided to shrink due to concerns about long-term use.

Her dose was gradually reduced over a year and a half, Buckley said, adding that her pain was no better, but her "mental energy" improved a little.

"He also thinks he's bolder than he was, so his wife went once or twice to say, 'Look, he's grumpy a lot more than he used to, but he's probably a little more mentally active.'

The patient also received physical therapy, one of the ways national guidelines advise doctors to treat pain in addition to opioids, but many provinces do not cover these costs, Buckley said.

"Many people don't have it. This is one of the push-pull parts of the problem. Optimal pain management includes more than medication. It includes education, sometimes cognitive behavioral therapy and exercise. But a significant part of the country doesn't can access them through their provincial health systems. ”

Buckley suggested that all provinces provide full opioid prescribing data to the Canadian Institute for Health Information, so that there is a more complete picture of what is happening across the country.

This report from The Canadian Press was first published on October 17, 2019.

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