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Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study

INTRODUCTION: The recent publication of a national guideline and quality standards in Canada have provided clinicians with new, evidence-based recommendations on safe, appropriate opioid use. We sought to characterize how well opioid initiation practices aligned with these recommendations before and...

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Autores principales: Gomes, Tara, Men, Siyu, Campbell, Tonya J., Tadrous, Mina, Mamdani, Muhammad M., Paterson, J. Michael, Juurlink, David N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731435/
https://www.ncbi.nlm.nih.gov/pubmed/36480526
http://dx.doi.org/10.1371/journal.pone.0278508
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author Gomes, Tara
Men, Siyu
Campbell, Tonya J.
Tadrous, Mina
Mamdani, Muhammad M.
Paterson, J. Michael
Juurlink, David N.
author_facet Gomes, Tara
Men, Siyu
Campbell, Tonya J.
Tadrous, Mina
Mamdani, Muhammad M.
Paterson, J. Michael
Juurlink, David N.
author_sort Gomes, Tara
collection PubMed
description INTRODUCTION: The recent publication of a national guideline and quality standards in Canada have provided clinicians with new, evidence-based recommendations on safe, appropriate opioid use. We sought to characterize how well opioid initiation practices aligned with these recommendations before and following their release. METHODS: We conducted a population-based study among people initiating opioids prior to the release of national guidelines (April 2015—March 2016; fiscal year [FY] 2015) and in the most recent year available (January—December 2019) in Ontario, Canada. We used linked administrative claims data to ascertain the apparent indication for opioid therapy, and characterized the initial daily dose (milligrams morphine or equivalent; MME) and prescription duration for each indication. RESULTS: In FY2015, 653,885 individuals commenced opioids, compared to 571,652 in 2019. Over time, there were small overall reductions in the prevalence of initial daily doses exceeding 50MME (23.9% vs. 20.1%) and durations exceeding 7 days (17.4% vs. 14.8%); but the magnitude of the reductions varied widely by indication. The prevalence of high dose (>50MME) initial prescriptions reduced significantly across all indications, with the exception of dentist-prescribed opioids (13.6% vs. 12.1% above 50MME). In contrast, there was little change in initial durations exceeding 7 days across most indications, with the exception of some surgical indications (e.g. common excision; 9.3% vs. 6.2%) and among those in palliative care (35.2% vs. 29.2%). CONCLUSION: Despite some modest reductions in initiation of high dose and long duration prescription opioids between 2015 and 2019, clinical practice is highly variable, with opioid prescribing practices influenced by clinical indication. These findings may help identify medical specialties well-suited to targeted interventions to promote safer opioid prescribing.
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spelling pubmed-97314352022-12-09 Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study Gomes, Tara Men, Siyu Campbell, Tonya J. Tadrous, Mina Mamdani, Muhammad M. Paterson, J. Michael Juurlink, David N. PLoS One Research Article INTRODUCTION: The recent publication of a national guideline and quality standards in Canada have provided clinicians with new, evidence-based recommendations on safe, appropriate opioid use. We sought to characterize how well opioid initiation practices aligned with these recommendations before and following their release. METHODS: We conducted a population-based study among people initiating opioids prior to the release of national guidelines (April 2015—March 2016; fiscal year [FY] 2015) and in the most recent year available (January—December 2019) in Ontario, Canada. We used linked administrative claims data to ascertain the apparent indication for opioid therapy, and characterized the initial daily dose (milligrams morphine or equivalent; MME) and prescription duration for each indication. RESULTS: In FY2015, 653,885 individuals commenced opioids, compared to 571,652 in 2019. Over time, there were small overall reductions in the prevalence of initial daily doses exceeding 50MME (23.9% vs. 20.1%) and durations exceeding 7 days (17.4% vs. 14.8%); but the magnitude of the reductions varied widely by indication. The prevalence of high dose (>50MME) initial prescriptions reduced significantly across all indications, with the exception of dentist-prescribed opioids (13.6% vs. 12.1% above 50MME). In contrast, there was little change in initial durations exceeding 7 days across most indications, with the exception of some surgical indications (e.g. common excision; 9.3% vs. 6.2%) and among those in palliative care (35.2% vs. 29.2%). CONCLUSION: Despite some modest reductions in initiation of high dose and long duration prescription opioids between 2015 and 2019, clinical practice is highly variable, with opioid prescribing practices influenced by clinical indication. These findings may help identify medical specialties well-suited to targeted interventions to promote safer opioid prescribing. Public Library of Science 2022-12-08 /pmc/articles/PMC9731435/ /pubmed/36480526 http://dx.doi.org/10.1371/journal.pone.0278508 Text en © 2022 Gomes et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gomes, Tara
Men, Siyu
Campbell, Tonya J.
Tadrous, Mina
Mamdani, Muhammad M.
Paterson, J. Michael
Juurlink, David N.
Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study
title Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study
title_full Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study
title_fullStr Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study
title_full_unstemmed Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study
title_short Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study
title_sort changing patterns of opioid initiation for pain management in ontario, canada: a population-based cross-sectional study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731435/
https://www.ncbi.nlm.nih.gov/pubmed/36480526
http://dx.doi.org/10.1371/journal.pone.0278508
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