Overview: A Turning Point in Canadian Opioid Prescribing
New findings from St. Michael’s researchers, published in the CMAJ, show that opioid prescribing for pain in Canada is trending downward. The study found an 8% decline in people newly starting opioids and an 11% drop in the total number of people accessing opioids during the study period. These changes come after years of policy shifts, education efforts, and national guidelines aimed at reducing opioid-related harms while ensuring appropriate pain management remains available.
Context: Why the Decline Matters
In the early 2000s, prescribing opioids rose sharply for acute and chronic non-cancer pain, paralleled by an increase in opioid-related harms. The proliferation of opioid products and aggressive marketing contributed to these increases both in Canada and abroad. Since then, Canada has implemented policy changes, enhanced continuing medical education for evidence-based prescribing, and published a national guideline for opioid prescribing in 2017. The CMAJ study contributes national context to these efforts, highlighting regional differences that may reflect how guidelines are implemented in practice.
What the Data Show
In 2022, roughly 1.8 million Canadians began using an opioid for pain relief for the first time. Yet the rate of new starts varied by province, with Ontario recording 55 new starts per 1,000 people and Alberta 63 per 1,000. Dr. Tara Gomes, a lead author from the Ontario Drug Policy Research Network at St. Michael’s Hospital, notes that interprovincial differences may signal uneven implementation of prescribing guidelines and underscores the need for coordinated national strategies and ongoing evaluation of patient outcomes.
Who Is Most Affected
The CMAJ report indicates higher annual rates of new prescriptions among females, older adults, and individuals living in lower-income neighborhoods and rural areas. The most commonly prescribed opioid varies by province: codeine is predominant in most areas, while Quebec favors morphine and hydromorphone. Notably, oxycodone dispensing has declined over time, though it still accounted for more than a quarter of opioids prescribed in Ontario in 2022.
Balancing Safety with Access
The authors warn that while reduced prescribing may reflect safer, more appropriate practices, there is a risk of unintended consequences if pain relief is compromised. Rapid dose tapering, abrupt discontinuation, or hesitancy to initiate opioid therapy when clinically needed can push patients toward unregulated sources, which are inherently more dangerous. Ongoing, coordinated care—ensuring patients have access to safe alternatives, gradual tapering when appropriate, and robust supports—remains essential.
Policy Implications and The Way Forward
The CMAJ study emphasizes the need for national coordination to address province-to-province variations in prescribing. Policymakers and practitioners should continue to monitor outcomes, invest in education on safe prescribing, and strengthen systems that support patients who rely on opioids for legitimate medical reasons. The ultimate goal is to reduce harms while preserving adequate pain management and patient autonomy.
Looking Ahead
As Canada moves forward, it will be crucial to evaluate how guideline implementation translates into real-world patient outcomes and to ensure safety nets are in place for those who depend on opioid medications for quality of life. The CMAJ study provides a valuable benchmark for ongoing assessment and signals the importance of balanced, patient-centered care in pain management.
