Ontario crackdown is curbing prescription opioid abuse, study says

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New research shows efforts to fight opioid painkiller misuse in Ontario are putting a small but important dent in the number of prescriptions provided to doctor-shoppers and others who abuse the system.

The province implemented new surveillance measures over the past three years, including a requirement for patients to show identification at pharmacies and a prescription monitoring database, to help prevent prescription drug abuse. A study published Tuesday in the journal CMAJ Open looked at those measures and found that "inappropriate prescriptions" of opioid drugs declined from 12,346 to 9,138 between October 2011 and May 2013.

But far too many inappropriate prescriptions for opioid painkillers and other abuse-prone drugs are still making it into the hands of patients, in part because of gaps in the new measures researchers say should be closed.

"I think there's still a fair way to go for us," said Tara Gomes, study author and scientist at Toronto's Institute for Clinical Evaluative Sciences and the Li Ka Shing Knowledge Institute at St. Michael's Hospital.

Prescription drug abuse is a major problem, particularly when it comes to opioids such as fentanyl or oxycodone, which are often prescribed to treat chronic pain despite a lack of evidence proving they are safe or effective over the long term. Other abuse-prone drugs examined in the study were benzodiazepines and stimulants.

The study evaluated Ontario's surveillance measures by looking at so-called inappropriate prescriptions dispensed under the public drug plan. It found that inappropriate prescriptions of opioid drugs accounted for 1.8 per cent of all opioids prescribed. Researchers defined inappropriate prescriptions as those dispensed to patients more than once within a week. The strict definition likely underestimates the true number of inappropriate prescriptions.

The decline to just over 9,000 prescriptions, however, is a drop in the bucket in the larger context of Canada's opioid epidemic. Many opioid-dependent patients are not recreational abusers who doctor-shop, but people in chronic pain who receive legitimate prescriptions.

Opioids have become a front-line treatment for chronic pain, despite a lack of evidence showing they work in those patients. Dependence can develop in a matter of weeks and because they are experiencing real pain, many patients have no trouble getting prescriptions renewed. In fact, many will continue receiving higher doses of medication as their tolerance builds, which increases the risk of dependence, side effects, accidental overdose and death. Federal Health Minister Rona Ambrose has said that doctors need to stop over-prescribing opioids, while physicians say they need help from the federal and provincial governments to find effective solutions.

Ms. Gomes, the study author, also noted several problems with Ontario's new surveillance measures. The system can't recognize when the same person uses different forms of ID at various pharmacies, meaning an individual can still fill multiple prescriptions. The province's drug monitoring program also doesn't allow doctors to see real-time data, making it impossible to tell if a patient has filled multiple opioid prescriptions in the previous few days.