Opioid crisis study: almost 1 in 4 in Ontario prescribed too much

Opioid crisis study: almost 1 in 4 in Ontario prescribed too much
For the first time since an opiate epidemic began to spread through Ontario, scientists have reopened the curtain on how doctors prescribe that narcotic, and the results are worrisome.
Almost a quarter of the first prescription opioids received a dose higher than the maximum recommended by experts, placing them at significantly higher risk of addiction, overdose, motor vehicle collisions and falls due to hip fracture, according to a study. by researchers with a leading expert in health care in Ontario, the Institute of Clinical Sciences Evaluation (ICES).
The dose that exceeded the maximum was even more common among those who recovered from surgery to replace a knee or hip: almost two in three received more than the equivalent of 50 mg of morphine, the highest initial dose recommended by American experts in 2016 year to control pain for all patients, but those who suffer from cancer.
Higher doses double the risk of overdose deaths and increase the chances of a motor vehicle collision between 20% and 40%, said Dr. Tara Gomes, the study’s lead author and ICES epidemiologist.
While people who die from opioid addictions often consume those drugs for a long time, reducing the rate of addiction could, over time, reduce the death rate, Gomes said.
“We can avoid some of those deaths,” he told Postmedia.
It was not until 2012 that Ontario began to track the practices of physicians who prescribe opiates. Before that, the quality of the prescription data was too poor to make meaningful findings, Gomes said.
Ontario first made new and better data available to scientists a year and a half ago, he said, and that is what allowed the study, which will be published on Wednesday in the journal Pain.
The study findings are based on a review of opioid prescriptions for the first time for more than 650,000 people in Ontario from April 1, 2015 through March 31, 2016.
Among the findings:
In a single year, doctors prescribed opioids to 1,957,552 people, all of whom, except for 19,024, had unique OHIP cards.
Nearly 60 percent of the prescription opioids had previous prescriptions for that narcotic.
Doses that were too high were not the only concern; some doctors also prescribed opioids for longer than the maximum recommended duration of seven days.
Of those prescription opioids, 151,874 (23%) managed dental pain but typically with smaller doses for short periods, 113,605 recovered from surgery, 78,155 had more general musculoskeletal pain, almost as many recovered from trauma, while 42,832 – only 6.5 percent – had pain associated with cancer or palliative care.
Doctors prescribed opioids more frequently for joint and muscle pain instead of back pain.
“Improvements in safe prescription of opioids can be achieved by focusing on the patterns of dose initiation among surgeons,” the study found.
The Canadian guidelines adopted last year are not binding, as there may be some patients for whom the benefits outweigh the dose risks or durations that are longer than the guidelines suggest, Gomes said. But those exceptions do not explain an excessive prescription rate of nearly a quarter, he said.
Spreading the word about those guidelines has proven to be a challenge because pain management covers many different areas of medical practice, he said. Some doctors may prescribe too much for too long because they are not up to date with last year’s guidelines, he said, a problem he expects the study to correct.

Mangat Media

Rajbir Mangat

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