Prescription Opioid Use, Harms and
Interventions in Canada: A Review Update of
New Developments and Findings since 2010
Authors: Fischer Benedikt 
Published: February 2021

Background: Canada has featured the second-highest levels of prescription opioid (PO) use
globally behind the United States, and reported extensive PO-related harms (e.g., non-medical PO
use [NMPOU], PO-related morbidity and mortality). A recent comprehensive review synthesized key
data on PO use, PO-related harms, and interventions in Canada, yet a substantive extent of new
studies and data have emerged.
Objective: To conduct and present a comprehensive review update on PO use, PO-related harms,
and interventions in Canada since 2010.
Study Design: Narrative review
Methods: We conducted literature searches, employing pertinent keywords, in key databases,
focusing on PO-related studies/data in/for Canada since 2010, or pertinent studies/data from earlier
periods not included in our previous review. In addition, we identified relevant data from “grey”
literature (e.g., government, survey, other data or system reports). Relevant data were screened
and extracted, and categorized into 4 main sections of indicators: 1) PO dispensing and use, 2)
non-medical PO use, 3) PO-related morbidity/mortality, 4) PO-related interventions and impacts.
Results: PO-dispensing in Canada overall continued to increase and/or remain at high levels in
Canada from 2010 to 2013, with the exception of the province of Ontario where marked declines
occurred starting in2012; quantitative and qualitative PO dispensing patterns continued to vary
considerably between provinces. Several studies identified common “high PO dosing” prescribing
practices in different settings. Various data suggested declining NMPOU levels throughout most
general (e.g., adult, students), yet not in special risk (e.g., street drug users, First Nations) populations.
While treatment demand in Ontario plateaued, rising PO-related driving risks as well as neo-natal
morbidity were identified by different studies. PO-related mortality was measured to increase – in
total numbers and proportionally – in various Canadian jurisdictions. Select reductions in general
PO and/or high-dose PO dispensing were observed following key interventions (e.g., Oxycodone
delisting, prescription monitoring program [PMP] introduction in Ontario/British Columbia). While
physician education intervention studied indicated mixed outcomes, media reporting was found to
be associated with PO prescribing patterns.
Limitations: The present review did not utilize systematic review standards or meta-analytic
techniques given the large heterogeneity of data and outcomes reviewed.
Conclusions: Recently emerging data help to better characterize PO-related use, harm and
intervention indicators in Canada’s general context of comparatively high-level PO dispensing and
harms, yet major gaps in monitoring and information persist; this continues to be a problematic
challenge, especially given the implementation of key PO-related interventions post-2010, the
impact of which needs to be properly measured and understood.
Key words: Prescription opioids, use, dispensing, dosing, education, non-medical use, Canada,
morbidity, mortality, monitoring, interventions, policy, review