The overprescribing of opioid medication, implicated in several North American jurisdictions for fuelling an overdose crisis that has decimated communities and killed thousands, does not appear to be a significant factor in British Columbia.
The preliminary findings by the BC Centre for Disease Control (BCCDC) come as the B.C. government prepares a lawsuit seeking compensation from pharmaceutical companies for the harm that opioids have done. But while prescribing practices have come under fire across Canada and in the United States, it does not appear to be a driver of the overdose crisis that has killed about 4,000 people in the province since the beginning of 2015.
The BCCDC, which has analyzed prescription-drug usage among people who overdosed in recent years, is expected to release its findings in coming months. That follows a report by the BC Coroners Service released last week, which found that, among other things, nearly half (45 per cent) of the people whose deaths were studied had sought help for physical pain in the year preceding their deaths.
For its analysis, the BCCDC reviewed the prescription-drug patterns of use among people who had both fatally and non-fatally overdosed through 2015 and most of 2016, focusing specifically on recent prescription-drug initiation, recent discontinuation and active tapering of opioids prior to overdose.
“Early findings suggest that all three types of prescription opioid for pain use are relatively rare among individuals who overdosed, and do not appear to be important drivers of the overall drug overdose risk in the B.C. population,” reads a summary of the study.
Alexis Crabtree, public-health resident physician at the UBC School of Population and Public Health and co-lead of the BCCDC’s prescribing patterns working group of the provincial overdose cohort, said that while data on people’s histories of pain is limited, the group was able to review five years of prescribing data preceding each person’s overdose event, as well as data on use of health-care services, based on billing data.
“Compared to people who are similar in age, sex and location in the province, people who overdose – either a fatal or non-fatal overdose – have higher rates of opioid use,” Dr. Crabtree said.
“But that said, less than 50 per cent have any use of prescribed opioids in the five years before the overdose, and only one in 10 have an active prescription at the time of overdose.”
A report released in late 2017 by the Canadian Institute for Health Information (CIHI) found that British Columbia dispensed opioids at the second-lowest rate of all provinces, second only to Quebec; B.C. dispensed 5,496 defined daily doses (DDD) per 1,000 population while Quebec dispensed 3,601 per 1,000.
Alberta had the highest rate, at 7,955 DDD per 1,000, followed by Newfoundland and Labrador, at 7,878 per 1,000.
B.C. had initially adopted national guidelines on opioid prescribing – which included a cap on maximum daily dosages – but eventually revised them to give doctors more discretion amid complaints that some people were being denied adequate care because they were on drugs that had come to be associated with the overdose crisis.
Eric Cadesky, president of Doctors of B.C., an association of physicians, residents and medical students in the province, said the group’s priority remains working with patients to address causes of pain and identify individual care plans.
Owen Williamson, head of the section of Pain Medicine at Doctors of B.C., noted that the fact nearly half of the study cohort in the BC Coroners Service review had sought help for pain before overdose deaths highlights possible opportunities for interventions.
“The question that arises is: Is there lost opportunity when those people present complaining of pain?”