Opioid Prescribing in Canada: A Mixed Picture of Decline and Disparities
New research from St. Michael’s Hospital, part of Unity Health Toronto, shows a notable decline in opioid prescribing for pain across Canada, while highlighting persistent regional variations and the need for careful implementation of guidelines. The CMAJ study tracks changes in both new starts and overall usage, offering a national snapshot of how policy, education, and clinical practice are shaping pain management.
The Scale of Change
Between the early 2000s and 2022, Canada experienced a surge in prescription opioid availability, partly driven by broader product access and aggressive marketing. Since then, national efforts—ranging from policy reforms to ongoing medical education and a 2017 national guideline for opioid prescribing—have aimed to curb harms associated with opioids while preserving access for those who legitimately need analgesia.
The CMAJ study reports that the number of people newly starting opioids declined by 8% over the study period, and the total number of people accessing opioids declined by 11%. In 2022 alone, about 1.8 million Canadians began an opioid for pain management for the first time, underscoring that while progress has been made, a substantial number of patients still initiate opioid therapy each year.
Regional Variations and Their Implications
The study found meaningful interprovincial differences in initiation rates. Ontario recorded 55 new opioid starts per 1,000 people, while Alberta reported 63 per 1,000—an indicator that prescribing practices, guideline uptake, and local health policies are not uniform nationwide. These variations raise questions about how federal and provincial strategies can be coordinated to ensure consistent, evidence-based care across Canada.
<h2 Who Is Most Affected?
Annual prescribing rates were higher among females, older adults, and individuals living in lower-income neighborhoods and rural areas. These patterns highlight the need for targeted interventions that address equity and access, ensuring people who may be at higher risk of chronic pain or opioid-related harms receive appropriate, safe treatment options and supports.
What the Data Suggests About Guideline Impact
The research team notes that reductions in prescribing can reflect safer and more conservative clinical decision-making. Yet, they warn that improper implementation of guidelines can have unintended consequences, such as rapid tapering or abrupt discontinuation. In some cases, patients may seek opioids from the unregulated market when care is interrupted, a scenario associated with higher risk and harm.
Dr. Tara Gomes, a researcher with the Ontario Drug Policy Research Network at St. Michael’s Hospital, emphasizes the need for coordinated national strategies and ongoing evaluation of how guidelines affect patient outcomes. The findings call for a balance: improving safety and reducing harms while ensuring patients with legitimate pain relief have access to appropriate care and supports.
Policy and Practice: Navigating Safe Pain Management
Seeing a national decline in new starts is encouraging, but it is not the end of the story. Efforts must continue to align policy, education, and clinical practice with patient-centered care. This includes:
- Maintaining access to effective pain relief for those who need it, with appropriate monitoring and follow-up.
- Supporting clinicians with up-to-date evidence-based prescribing guidelines and education.
- Addressing regional disparities to ensure equitable care.
- Strengthening supports and care coordination to prevent abrupt changes in therapy.
Looking Ahead
The CMAJ study offers a baseline for national monitoring of prescription opioid use and its variation across populations. As Canada continues to refine its approach to pain management, ongoing data collection and cross-jurisdiction collaboration will be essential. The goal remains clear: reduce opioid-related harms without compromising legitimate access to effective pain relief.
