Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis

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Figure 1
Rate of dispensing of long-acting opioids (in milligrams of morphine equivalents [MMEs] per 1000 population) in Canada, May 2008-April 2016, by province.
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Figure 2
Rate of dispensing of immediate-release opioid dispensing (in milligrams of morphine equivalents [MMEs] per 1000 population) in Canada, May 2008-April 2016, by province.
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Figure 3
Figure 3: Rate of dispensing of long-acting opioids (in milligrams of morphine equivalents [MMEs] per 1000 population) in Canada, May 2008-April 2016, by opioid type.

Table 1: Characteristics of opioid formulations included in the study

Drug	Morphine conversion factor	Long-acting opioid formulations		Short-acting opioid formulations
Drug	Morphine conversion factor	Formulation	Unit dosage range	Formulation	Unit dosage range
Oxycodone	1.71	Oral	5-80 mg	Oral	2.5-20 mg
Hydromorphone	4.5	Oral	3-32 mg	Oral	1-8 mg
Morphine	1	Oral	10-200 mg	Oral	1-60 mg
Fentanyl	12 µg/h: 52	Transdermal	12-100 µg/h	-	-
	25 µg/h: 97
	37 µg/h: 157
	50 µg/h: 202
	75 µg/h: 292
	100 µg/h: 382
Codeine	0.15	Oral	50-200 mg	Oral	5-60 mg

Table 2: Summary of long-acting opioid prescription patterns by province at the beginning and end of the study period

Province	May 2008-October 2008				November 2015-April 2016				Overall comparisons
Province	No. of prescriptions	No. of prescriptions per 100 000	No. of units per prescription	No. of MMEs per prescription	No. of prescriptions	No. of prescriptions per 100 000	No. of units per prescription	No. of MMEs per prescription	% change prescription rate	% change no. of MMEs per prescription
British Columbia	206 016	4579	53	3162	258 498	5492	40	1672	19.9	-47.1
Alberta	149 800	3952	71	4490	221 583	5236	58	3038	32.5	-32.3
Saskatchewan	48 198	4520	56	3792	68 742	6016	53	2761	33.1	-27.2
Manitoba	50 867	4123	59	4041	61 860	4744	50	2553	15.1	-36.8
Ontario	840 124	6334	63	4508	1 047 412	7549	48	2397	19.2	-46.8
Quebec	412 153	5147	32	2153	648 582	7819	25	1131	51.9	-47.5
New Brunswick	41 005	5427	56	3309	54 297	7194	52	2462	32.6	-25.6
Nova Scotia	38 344	4060	74	4186	66 800	7063	52	2347	74.0	-43.9
Prince Edward Island	5096	3538	67	3261	7578	5157	66	2750	45.8	-15.7
Newfoundland and Labrador	18 830	3586	54	3473	32 144	6084	46	2515	69.6	-27.6
Average		4527	59	3638		6236	49	2362	37.8	-35.1