{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T02:16:35Z","timestamp":1773886595124,"version":"3.50.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T00:00:00Z","timestamp":1670457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["153070"],"award-info":[{"award-number":["153070"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The recent publication of a national guideline and quality standards in Canada have provided clinicians with new, evidence-based recommendations on safe, appropriate opioid use. We sought to characterize how well opioid initiation practices aligned with these recommendations before and following their release.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a population-based study among people initiating opioids prior to the release of national guidelines (April 2015\u2014March 2016; fiscal year [FY] 2015) and in the most recent year available (January\u2014December 2019) in Ontario, Canada. We used linked administrative claims data to ascertain the apparent indication for opioid therapy, and characterized the initial daily dose (milligrams morphine or equivalent; MME) and prescription duration for each indication.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In FY2015, 653,885 individuals commenced opioids, compared to 571,652 in 2019. Over time, there were small overall reductions in the prevalence of initial daily doses exceeding 50MME (23.9% vs. 20.1%) and durations exceeding 7 days (17.4% vs. 14.8%); but the magnitude of the reductions varied widely by indication. The prevalence of high dose (&gt;50MME) initial prescriptions reduced significantly across all indications, with the exception of dentist-prescribed opioids (13.6% vs. 12.1% above 50MME). In contrast, there was little change in initial durations exceeding 7 days across most indications, with the exception of some surgical indications (e.g. common excision; 9.3% vs. 6.2%) and among those in palliative care (35.2% vs. 29.2%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Despite some modest reductions in initiation of high dose and long duration prescription opioids between 2015 and 2019, clinical practice is highly variable, with opioid prescribing practices influenced by clinical indication. These findings may help identify medical specialties well-suited to targeted interventions to promote safer opioid prescribing.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0278508","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T18:28:33Z","timestamp":1670524113000},"page":"e0278508","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-1965","authenticated-orcid":true,"given":"Tara","family":"Gomes","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siyu","family":"Men","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8459-208X","authenticated-orcid":true,"given":"Tonya J.","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1911-6129","authenticated-orcid":true,"given":"Mina","family":"Tadrous","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad M.","family":"Mamdani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5995-1714","authenticated-orcid":true,"given":"J. Michael","family":"Paterson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David N.","family":"Juurlink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"pone.0278508.ref001","unstructured":"Government of Canada. Opioid and Stimulant-Related Harm in Canada 2020 https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/graphs?index=791."},{"key":"pone.0278508.ref002","unstructured":"U.S. Centers for Disease Control and Prevention. Opioid Data Analysis and Resources 2021 https:\/\/www.cdc.gov\/drugoverdose\/data\/analysis.html."},{"key":"pone.0278508.ref003","unstructured":"Public Health Ontario. 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Understanding the Epidemic 2020 https:\/\/www.cdc.gov\/drugoverdose\/epidemic\/index.html."},{"issue":"15","key":"pone.0278508.ref006","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC Guideline for Prescribing Opioids for Chronic Pain\u2014United States, 2016","volume":"315","author":"D Dowell","year":"2016","journal-title":"JAMA"},{"issue":"18","key":"pone.0278508.ref007","doi-asserted-by":"crossref","first-page":"E659","DOI":"10.1503\/cmaj.170363","article-title":"Guideline for opioid therapy and chronic noncancer pain","volume":"189","author":"JW Busse","year":"2017","journal-title":"CMAJ"},{"key":"pone.0278508.ref008","unstructured":"Health Quality Ontario. Opioid Prescribing for Acute Pain. 2018."},{"key":"pone.0278508.ref009","unstructured":"Health Quality Ontario. 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