Impact of delisting high‐strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada

Abstract

Purpose High‐strength opioid formulations were delisted (removed) from Ontario's public drug formulary in January 2017, except for palliative patients. We evaluated the impact of this policy on opioid utilization and dosing. Methods We conducted a longitudinal study among patients receiving publicly funded, high‐strength opioids from August 2016 to July 2017. The primary outcome measure was weekly median daily opioid dose (in milligrams of morphine or equivalent; MME) of (1) publicly funded and (2) all opioid prescriptions irrespective of funding source, evaluated using interrupted time series analyses and stratified by palliative care status. Results Following policy implementation, the weekly median daily dose of publicly funded opioids decreased immediately among non‐palliative patients by 10 MME (95% confidence limit [CL], −16.8 to −3.1) from a pre‐intervention dose of 424.5 MME (95% CL, 417.8‐431.2) and fell gradually among palliative patients by 3.9 MME per week (95% CL, −5.5 to −2.3) from a pre‐intervention dose of 450.1 MME (95% CL, 432.5‐467.7). In contrast, among all opioid prescriptions, gradual reductions in weekly median daily doses were observed only for non‐palliative patients, which decreased by 0.7 MME per week (95% CL, −1.3 to −0.2) from a pre‐intervention dose of 426.2 MME (95% CL, 420.9‐431.5). Conclusion The delisting of publicly‐funded, high‐strength opioids was accompanied by changes in funding source and small reductions in the weekly median daily doses dispensed. Although observed dose reductions of less than 1 MME weekly are likely not clinically relevant, safety implications of these changes require further monitoring.

The Role of the Medical School Training on Physician Opioid Prescribing Practices: Evidence from Ontario, Canada: Le rôle de la formation à la faculté de médecine à l’égard des pratiques de prescription d’opioïdes des médecins: données probantes d’Ontario, Canada

“…17 In Ontario, the Narcotics Monitoring System was introduced in May 2012 to collect and monitor data on all narcotics dispensed. 18 The introduction of a fentanyl patch-for-patch program, 19 which requires patients prescribed fentanyl return used patches to pharmacies before receiving more patches, and the delisting of high-strength opioids from the Ontario formulary (except for palliative patients) 20 have also helped curb opioid prescribing.…”

Comparison of Prescribing Patterns Before and After Implementation of a National Policy to Reduce Inappropriate Alprazolam Prescribing in Australia

“…Likewise, in Ontario, Canada, after high-strength opioids were delisted from the public formulary, 1 in 3 people accessed them via private insurance or by paying for the medication out of pocket. 6…”

“…1,2,3,4 A common approach used by third-party payers to reduce inappropriate use of prescribed medications is to restrict the conditions under which medications are reimbursed. 5,6,7 While these policies have the potential to change the way in which medications are prescribed and used, they are relatively imprecise tools that can also lead to unintended consequences. 8,9,10 Previous policy interventions targeting benzodiazepines have had mixed results, as they did not selectively target people who were inappropriately prescribing or misusing benzodiazepines.…”

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

“…These databases are routinely used to study the impact of policy changes related to prescription opioids. [19, 20]…”