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Canadian and U.S. surgical patients filled opioid prescriptions at a rate nearly seven times higher than Swedish patients: study

September 4, 2019

A new study published today in JAMA Network Open found that patients in Canada and the U.S. who underwent one of four low-risk surgical procedures filled opioid prescriptions within a week after discharge at a rate that was nearly seven times higher than patients in Sweden.

The study – which focused on adults who underwent gallbladder removal, appendix removal, meniscus repair and breast lump removal – is the first of its kind to systematically evaluate the differences in the use of opioids after surgery for patients receiving similar procedures in different countries.

About 76 per cent of the U.S. patients and nearly 79 per cent of the Canadian patients filled a prescription for opioids after their surgery versus just 11 per cent of Swedish patients.

Researchers found that patients in the United States received significantly higher doses of opioids compared to patients treated in Canada and Sweden. The findings were consistent for each of the four surgical procedures assessed.

“There is clear variability in the use of opioids after surgery in different countries,” says Dr. Karim Ladha, a clinician-scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and co-author of the study.

“Opioids are routinely prescribed for postoperative pain management in many countries, however the findings suggest the potential to reevaluate prescribing practices internationally.”

The study examined the frequency, amount and type of opioids dispensed after surgery and points to differences in practitioners’ approaches to opioid prescribing, public attitudes regarding the role of opioids in treating pain, and broader structural factors related to drug marketing and regulation.

“We found that certain types of opioids, such as codeine and tramadol, were prescribed more often in Canada. While prescribers may view these so-called weak opioids as safer alternatives, there is still the potential for misuse and life-threatening adverse effects,” says Dr. Hannah Wunsch, staff physician, department of critical care medicine at Sunnybrook Health Sciences Centre, a co-author of the study and adjunct scientist with the not-for-profit research institute ICES, where the Canadian data were analyzed.

Excessive postoperative opioid prescribing has been associated with increased risks of drug diversion, new long-term opioid use, and the development of opioid use disorder. In 2018, nearly 4,500 opioid-related deaths occurred in Canada.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancercare, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit unityhealth.to.

About Sunnybrook Health Sciences Centre

Sunnybrook Health Sciences Centre is inventing the future of health care for the 1.3 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The hospital also has a unique and national leading program for the care of Canada’s war veterans. For more information about how Sunnybrook is inventing the future of health care, visit sunnybrook.ca.

About ICES

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario.

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