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Restrictions on prescribing oxycodone followed by increases in other strong opioid use and opioid-related deaths in Ontario, CAMH research shows

CAMH researchers find that dispensing of other strong opioids and opioid-related deaths continue to rise despite reductions in oxycodone dispensing.

TORONTO, July 24, 2015 – New research from the Centre for Addiction and Mental Health (CAMH) reveals that dispensing of other strong opioids, like fentanyl and hydromorphone, and the number of opioid-related deaths in Ontario have continued to rise despite government restrictions on prescribing extended-release oxycodone and the implementation of a provincial narcotics monitoring system in early 2012. 

The study, published in the journal Pain Physician, is the first to review opioid dispensing trends and related deaths from 2005 to as recent as 2013.

Prescription pills
“These new data show that these select government measures implemented in early 2012, have not reduced the total number of opioid-related deaths in Ontario,” said Dr. Benedikt Fischer, Senior Scientist at CAMH and lead author of the study. “Rather, rates of death have continued to rise.” 

Consumption of prescription opioids in Canada, a class of powerful drugs that are primarily prescribed to treat acute or chronic  pain, have steeply risen through the years 2000 – 2010 to population levels which are second only to the United States in global comparison, says Dr. Fischer.

A key driver for the continuously increasing opioid-related deaths are substantive increases in the number of deaths related to  other strong opioids that are not subject to the same restrictions as oxycodone, what Dr. Fischer calls a “substitution effect”.  In addition to oxycodone, the research team investigated dispensing trends for fentanyl and hydromorphone. “We found that increases in dispensing hydromorphone and fentanyl partly offset the reduction seen in oxycodone dispensing,” said Dr. Fischer. “In many instances, fentanyl or hydromorphone are now prescribed where previously an oxycodone product would have been given”.

Specifically, from 2010 to 2013 dispensing of oxycodone dropped by 44 per cent. However, during the same time period, dispensing of hydromorphone increased by 56 per cent and fentanyl by nearly 16 per cent. While oxycodone-related overdose deaths, based on data from the Office of the Chief Coroner of Ontario, declined substantively from 174 in 2010 to 131 in 2013 (30 per cent), overall prescription opioid deaths continued to rise, from 467 in 2010 to 577 in 2013 (24 per cent), with rising levels of overdose fatalities related to the other opioid formulations.

“Clearly this continues to be a huge problem and recent measures to counteract the devastating collateral harms of prescription opioids have had rather limited impact and have not reduced the number of people who are dying from these drugs,” said Dr. Fischer. “These findings show that there is limited utility for public health in interventions that focus mainly on one type of opioid. We need to take a more comprehensive approach that includes more evidence-based prescribing of opioids while ensuring pain patients receive the best possible care when needed.” 

The study was funded in part by the Canadian Institutes of Health Research (CIHR).

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The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit or follow us on Twitter @CAMHnews.

For further information please contact:

Kate Richards
Media Relations, CAMH
416-535-8501 ext. 36015




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