Characteristics and Incidence of Opioid Analgesic Initiations to Opioid Naive Patients in a Canadian Primary Care Setting

Objective: To examine characteristics and incidence of opioid analgesic initiations to opioid naive patients in a Canadian primary care setting. Methods: This is a population-based cross-sectional study, outlining an analysis of health administrative data recorded in a centralized medication monitoring database (PharmaNet) covering 96% of population in British Columbia, Canada. From the PharmaNet database, 5657 doctors (87% of all practicing family physicians) were selected on the bases of (1) having been currently treating patients (defined as having written at least 25 prescriptions, for any drug, in preceding 12months); and (2) having prescribed at least 1 opioid during study period. The primary outcome measure is incidence of new starts for opioid analgesics in opioid naive people, stratified by several important prescriber and regional characteristics (eg, graduation year, geographical location). Results: Between December 1, 2018 and November 30, 2019, there were 139,145 opioid initiations to opioid naive patients. The mean monthly initiation rate was 2.05 prescriptions per physician. Most initiations were in Lower Mainland regions of British Columbia, also where the population is most concentrated (46,456, 33% in the Fraser region), by prescribers who graduated between 1986 and 1995 (39,601, 28%), and had less than 10 patient visits per day (72,506, 52%). Conclusions: From data presented in this study, it appears that the rate of opioid analgesic initiations in primary care remains unchanged. Individualized prescribing interventions targeted at physicians are urgently needed considering the current opioid epidemic and known links with opioid analgesics that raise concerns about the potential to cause harm.