Laura Desveaux, PhD and Dr. Noah Ivers

Addressing Canada’s Opioid Crisis

Working with family doctors to improve opioid prescribing

There is an opioid epidemic in Canada. According to Statistics Canada, 4,460 Canadians died due to an opioid overdose in 2018.  While much of the public discussion has focused on reducing overdoses and providing addiction treatment, there has been little discussion on the role of primary care. This lack of discussion is surprising given that family physicians are the single largest group of opioid prescribers in North America.

The Ontario Healthcare Implementation Laboratory (OHIL), an initiative led by the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) and several provincial organizations and agencies, is addressing this disparity in attention. OHIL is leveraging data to evaluate large-scale quality improvement activities in the health system. Currently, the team is conducting a series of research studies assessing the role of family doctors in improving opioid prescribing practices.

There are significant variations in the views of family physicians on the role of opioids, which has translated to widely varying prescribing rates. The research conducted by the WIHV team has found that, to date, interventions to improve opioid prescribing and chronic pain management in primary care are often homogenous in their approach, and as a result aren’t particularly effective. 

Family physicians are caught between what they were taught in medical school versus what current evidence now supports as best practice when it comes to opioid prescribing. Many struggle to balance their patient’s expectations with those of the health system. “Family physicians across the board who participated in our work expressed that they felt unsupported in their efforts to manage chronic pain”, said Laura Desveaux, PhD, a scientist at WIHV and Women’s College Research Institute (WCRI). 

Opioids in Canada

  • Ontario has one of the highest opioid prescribing rates in Canada
  • 14 per cent of Ontario’s population filled an opioid prescription in 2015-2016
  • Overall quantity of opioids dispensed in Canada declined roughly 10 per cent between 2016 and 2017
  • Highest prescribers prescribe opioids 55x more often than lowest prescribers

“When it comes to opioid prescribing, the physicians’ beliefs about the consequences of opioid use and their belief in their ability to effectively navigate emotionally charged conversations with patients surrounding their opioid use were key determinants in whether or not they prescribed an opioid,” Desveaux added.

“While our research continues, our work shows that there is an opportunity to enhance intervention strategies targeting family physicians in order to more effectively support them in managing their patients’ high-risk opioid prescriptions,” explained Dr. Noah Ivers, WIHV’s lead scientist for the OHIL initiative, a WCRI scientist, and Women’s College Hospital (WCH) family physician. “Our next step will be to launch a multi-phased trial and process evaluation to better understand which activities best support family physicians.”

Through OHIL, WIHV is working with its partners to better understand the root causes of health system issues, like the opioid epidemic, and generate evidence-based solutions.