Overview: Opioid prescribing trends in Canada
Canadian research from St. Michael’s Hospital highlights a significant shift in how opioids are prescribed for pain. The study, published in the Canadian Medical Association Journal (CMAJ), finds that the rate of people newly starting prescription opioids declined by 8 percent during the study period, and the total number of individuals accessing opioids decreased by 11 percent. These findings come amid a broad set of national efforts aimed at reducing opioid-related harms, including guideline-based prescribing, continuing medical education, and policy changes implemented since the early 2000s.
The data provide important national context: in 2022, roughly 1.8 million Canadians began an opioid therapy for the first time. Yet the pace of starts differed across provinces, signaling that provincial strategies and implementation approaches may influence patient outcomes and access to needed pain relief.
What drove the decline?
Researchers point to a constellation of factors that may have contributed to reduced opioid initiation and use. These include the dissemination of evidence-based prescribing guidelines published in 2017, a strengthened emphasis on safe prescribing in continuing medical education, and policy measures designed to curb overuse and harms associated with opioids. The interprovincial differences observed in the study suggest that how guidelines are adopted and monitored can shape prescribing patterns at the local level.
Provincial variations and what they mean
Gaps between provinces were evident. Ontario started fewer new opioid prescriptions per 1,000 people compared with Alberta in 2022 (Ontario 55 vs. Alberta 63). Such variation may reflect differences in guideline implementation, access to alternative pain management options, and health system supports. The authors emphasize the need for coordinated national strategies paired with ongoing evaluation to understand how changing prescribing practices affect patient outcomes, including pain control and risk of harm.
Who is most affected by prescribing changes?
Annual rates of new opioid prescriptions were higher among females, older adults, and people living in lower-income neighbourhoods or rural areas. Opioid types also shifted over time: codeine remained the most commonly prescribed opioid in most provinces, while Quebec favored morphine and hydromorphone. Oxycodone dispensing declined overall, though in Ontario it still accounted for more than one-quarter of opioid prescriptions in 2022. These patterns illustrate how regional prescribing cultures and drug availability shape patient experiences and access to relief.
Clinical balance: safety and access to pain relief
The CMAJ authors caution that declining prescribing rates may reflect a concerted effort to promote safer, more appropriate use, but they warn of potential unintended consequences. Rapid tapering, abrupt discontinuation, or hesitation to initiate opioids when clinically indicated can push patients toward unregulated sources, which are often more dangerous. The study underscores the need for careful patient-centered care, with coordination of supports such as alternative therapies, gradual dose adjustments when necessary, and clear pathways for ongoing management of pain.
Implications for policy and practice
Beyond reducing harm, the findings call for balanced messaging that preserves access to effective pain management. Policymakers and clinicians should consider how to align national guidelines with provincial delivery, ensuring that patients who benefit from opioids for legitimate medical reasons are not underserved. Ongoing monitoring and evaluation will be essential to determine whether reduced initiation translates into improved safety without compromising pain relief and function.
Conclusion
As Canada continues to refine its approach to opioid prescribing, the CMAJ study provides valuable national insight while highlighting regional differences that matter for care. Dr. Tara Gomes and colleagues stress that careful implementation of guidelines and supportive care are key to sustaining safe, effective pain management across the country.
