Patterns, Changes, and Trends in Prescription
Opioid Dispensing in Canada, 2005–2016
Authors: Fischer Benedikt 
Published: October 2019

Background: Levels of prescription opioid (PO) dispensing have been rising in Canada –
also in global comparison – since the mid-2000s, and are co-occurring with extensive POrelated morbidity and mortality. Previous analyses have demonstrated correlations between
PO dispensing and related harm levels, yet also distinct heterogeneous interprovincial POdispensing patterns, in regards to quantities and individual PO formulations. Several systemlevel interventions have been implemented recently (since 2012) to address high PO-use levels
and related harms in Canada; the effects of these interventions on PO-dispensing levels remain
largely unexamined.
Objectives: Our aim was to examine over-time patterns and trends of levels of PO dispensing
quantitatively (in defined daily doses [DDDs]) for ‘strong’ and ‘weak’ opioids and qualitatively
(by individual PO formulations) by province and Canada total, for the period of 2005–2016.
Methods: We examined annual PO-dispensing levels, by ‘weak’ and ‘strong’ POs (individual
PO formulations, but excluding methadone), by province and for Canada total, from 2005–
2016. Raw dispensing information for POs were obtained from IMSQuintiles CompuScript
[new name: IQVIA], based on monthly retail dispensing data from a representative sample of
community pharmacies covering about 80% of all dispensing episodes in Canada. These data
were converted into annual dispensing values in DDDs (DDD/1,000 population/day), based
on standard methodology, for the PO formulation groups of interest. Patterns and trends of
‘strong’ and ‘weak’ POs and individual PO formulations were examined descriptively, aided
by segmented regression analyses to identify significant break-points in over-time trends.
In addition, changes in ‘strong’/‘weak’ PO dispensing ratios between 2005 and 2016 were
examined.
Results: ‘Weak’ PO use remained largely stable across Canada over the study period. For
‘strong’ PO dispensing, half of the provinces featured consistent increases, while remaining
provinces presented initial increases with subsequently reverting downward trends at
divergent levels. Dispensing of individual ‘strong’ PO formulations varied interprovincially;
specifically, substantial decreases for oxycodone co-occurred with increases in other ‘strong’
PO formulations. The dispensing ratios for ‘strong’/‘weak’ POs increased significantly across
jurisdictions between 2005 and 2016 (P < .05).
Limitations: Retail pharmacy-based data do not cover the total – but the large majority
– of PO dispensing in Canada. There are limitations to DDD/1,000 population/day as a
comparative measurement unit for PO dispensing. The causal contribution of interventions
associated with changes in PO dispensing observed cannot be verified with the data available.
Conclusions: Heterogeneous trends for PO dispensing, driven mostly by variations in ‘strong’
PO use, continue to be observed provincially across Canada. Recent changes in PO dispensing
are likely influenced by recent intervention efforts (e.g., PO de-scheduling, monitoring,
guidelines) aiming to reduce PO-related harms, which, however, have shown limited impact on
PO-dispensing levels to date.
Key words: Opioids, prescribing, dispensing, interventions, policy, population, monitoring,
Canada