title: Trends in high-dose opioid prescribing in Canada.
abstract: OBJECTIVE
  To describe trends in rates of prescribing of high-dose opioid formulations and variations in opioid product selection across Canada.
  
  
  METHODS
  Population-based, cross-sectional study.
  
  
  METHODS
  Canada.
  
  
  METHODS
  Retail pharmacies dispensing opioids between January 1, 2006, and December 31, 2011.
  
  
  METHODS
  Opioid dispensing rates, reported as the number of units dispensed per 1000 population, stratified by province and opioid type.
  
  
  RESULTS
  The rate of dispensing high-dose opioid formulations increased 23.0%, from 781 units per 1000 population in 2006 to 961 units per 1000 population in 2011. Although these rates remained relatively stable in Alberta (6.3% increase) and British Columbia (8.4% increase), rates in Newfoundland and Labrador (84.7% increase) and Saskatchewan (54.0% increase) rose substantially. Ontario exhibited the highest annual rate of high-dose oxycodone and fentanyl dispensing (756 tablets and 112 patches per 1000 population, respectively), while Alberta's rate of high-dose morphine dispensing was the highest in Canada (347 units per 1000 population). Two of the highest rates of high-dose hydromorphone dispensing were found in Saskatchewan and Nova Scotia (258 and 369 units per 1000 population, respectively). Conversely, Quebec had the lowest rate of high-dose oxycodone and morphine dispensing (98 and 53 units per 1000 population, respectively).
  
  
  CONCLUSIONS
  We found marked interprovincial variation in the dispensing of high-dose opioid formulations in Canada, emphasizing the need to understand the reasons for these differences, and to consider developing a national strategy to address opioid prescribing.
authors.affiliation: Scientist at the Institute for Clinical Evaluative Sciences; Assistant Professor at the Institute for Health Policy, Management and Evaluation and the Leslie Dan Faculty of Pharmacy at the University of Toronto; and Scientist at the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto, Ont. gomest@smh.ca.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.affiliation: Scientist at the Institute for Clinical Evaluative Sciences; Professor at the Institute for Health Policy, Management and Evaluation, the Department of Medicine, and the Leslie Dan Faculty of Pharmacy at the University of Toronto; and Scientist at the Li Ka Shing Knowledge Institute and the Department of Medicine at St Michael's Hospital.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.affiliation: Scientist at the Institute for Clinical Evaluative Sciences and Assistant Professor in the Institute for Health Policy, Management and Evaluation at the University of Toronto and the Department of Family Medicine at McMaster University in Hamilton, Ont.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Scientist at the Institute for Clinical Evaluative Sciences; Assistant Professor at the Institute for Health Policy, Management and Evaluation and the Department of Medicine at the University of Toronto; and Associate Scientist at the Li Ka Shing Knowledge Institute and the Department of Medicine at St Michael's Hospital.
authors.forename: Irfan A
authors.initials: IA
authors.lastname: Dhalla
authors.affiliation: Scientist at the Institute for Clinical Evaluative Sciences; Scientist at the Sunnybrook Research Institute; and Professor at the Institute for Health Policy, Management and Evaluation, the Department of Medicine, and the Department of Pediatrics at the University of Toronto.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
mesh_terms: D000701:Analgesics, Opioid / Q000145:classification / Q000627:therapeutic use; D002170:Canada; D004305:Dose-Response Relationship, Drug; D006801:Humans; D054539:Medication Therapy Management / Q000706:statistics & numerical data / Q000639:trends; D020380:Needs Assessment; D059408:Pain Management / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends
chemical_list: D000701:Analgesics, Opioid