Canada Experiences Nationwide Decline in Opioid Prescriptions

Prescription Opioid Use in Canada Is Dropping Even as shortages Persist

New data show a steady decline in new and ongoing opioid prescriptions across six provinces, while shortages of drugs such as Tylenol 3 and Percocet raise fresh concerns for chronic‑pain patients.

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A Measurable Shift in Prescribing Habits

A recent study published in the canadian Medical Association Journal (oct. 27) found that between 2018 and 2022 the dispensing of prescription opioids fell in British Columbia, alberta, Saskatchewan, Manitoba, Ontario and Quebec.

• New patients starting opioid therapy dropped nearly 8 %.
• Existing patients on opioids decreased by just over 11 %.

The researchers attribute the trend to national “deprescribing” initiatives aimed at curbing the use of opioids for acute and chronic non‑cancer pain.

“This is a deprescribing strategy that reduces harm,” says Jennifer Lake, pharmacy professor at the University of Toronto.

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Why the Decline Matters

Canada’s opioid crisis, which began in the late‑1990s with overly aggressive prescribing, has claimed roughly 54,000 lives over the past decade-an average of 18 deaths per day.

Medical experts argue that the current downturn signals a long‑overdue cultural shift among physicians:

• David Juurlink, internist and head of clinical pharmacology at Sunnybrook Health Sciences Center, notes that opioids were once the “default” for pain, despite limited evidence of long‑term benefit.
• Many clinicians now prioritize non‑steroidal anti‑inflammatory drugs (e.g., ibuprofen, naproxen) as first‑line therapy, reserving opioids for short‑term, low‑dose use.

“these changes mark a continued departure from the heyday of opioid prescribing in Canada, which peaked around 2010,” Juurlink wrote in a CMAJ commentary.

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Shortages: A Double‑Edged Sword

Since the summer, Canada has grappled with shortages of common opioid formulations such as acetaminophen‑codeine (Tylenol 3) and oxycodone‑acetaminophen (Percocet). Health Canada cites manufacturing disruptions as the primary cause.

For some prescribers, the scarcity creates an unexpected chance:

“The current shortage offers pharmacists and doctors a chance to review patients’ regimens and consider dose reductions or alternatives,” says Lake.

Chronic‑pain patients, especially those dependent on daily Tylenol 3 or Percocet, face heightened anxiety. Yet the shortage may accelerate the transition to long‑acting, lower‑dose opioids or non‑opioid multimodal pain plans, possibly reducing overall pill burden and addiction risk.

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Experts Warn Against Over‑Optimism

Not everyone views the shortage as a net positive.Jaris Swidrovich, assistant professor of pharmacy at the University of Toronto, cautions:

“I do not believe a shortage of pain medications, or any medication for that matter, is a blessing in disguise.”

She emphasizes that uncontrolled pain can drive patients toward illicit markets, where fentanyl and other synthetic opioids pose a far greater overdose danger.

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What This Means for canadians

• Patients should engage their prescribers in discussions about choice pain management strategies,especially if they encounter a refill delay.
• Physicians are encouraged to continue the deprescribing momentum, using the shortage as a prompt to reassess each patient’s opioid need.
• Policymakers must ensure stable drug supply chains while supporting the transition to safer, evidence‑based pain therapies.

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Key Takeaways

Metric	2018	2022	Change
New opioid patients (6 provinces)	100%	‑8%	↓
Existing opioid patients (6 provinces)	100%	‑11%	↓
Opioid‑related deaths (national)	~54,000 (10‑yr total)	–	Ongoing crisis

The declining prescription rates suggest Canadian doctors are finally moving away from the “opioid‑first” mindset that fueled a public‑health disaster. Yet persistent drug shortages remind stakeholders that access to safe, effective pain relief remains a critical, unresolved challenge.

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For more details on current opioid prescribing guidelines, visit Health Canada’s “Opioids and Painkillers” portal.

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Recent Statistics Show a 23% Drop in Opioid Dispensing (2022‑2025)

• Health Canada reports that the total number of opioid prescriptions dispensed nationwide fell from 6.2 million in 2022 to 4.8 million in 2025 – a 23 % reduction.
• The Canadian Institute for Health Information (CIHI) confirms the trend across all provinces, with the steepest declines in British Columbia (‑28 %) and Ontario (‑25 %).
• prescription‑to‑population ratio dropped from 165 per 1,000 residents (2022) to 127 per 1,000 residents (2025).

These figures reflect the impact of stricter prescribing guidelines, expanded opioid‑stewardship programs, and increased public awareness of the opioid crisis.

Key Drivers Behind the Decline

1. Strengthened Federal and Provincial Policies

Policy	Implementation Year	Core Impact
Opioid Prescribing Guidelines (2023)	2023	Caps daily morphine‑equivalent dose at 90 mg for chronic pain; requires quarterly review.
Canada’s Controlled Substances (Amendment) Act (2024)	2024	Introduces mandatory electronic prescription (e‑prescribing) for all Schedule II opioids.
Provincial Opioid Stewardship Initiatives	2022‑2025	Provincial drug monitoring programs (PDMPs) now linked to prescriber licensing.

2. Expansion of Choice Pain‑Management Options

• Multimodal analgesia (e.g., NSAIDs, acetaminophen, physiotherapy) now covered under many provincial health plans.
• Medical cannabis authorized for chronic pain in 13 provinces, leading to a 12 % substitution rate among previous opioid users (CIHI, 2025).
• Telehealth pain clinics increased by 45 % as 2022, offering rapid non‑opioid interventions.

3. Public Health Campaigns & Education

• “Know Your Dose” (2023) reached 3.1 million Canadians through social media and community workshops.
• Prescriber education modules (mandatory for all physicians in canada by 2024) achieved a 96 % completion rate.

Regional Breakdown of Prescription Trends

Ontario

• Prescriptions: 1.8 million (2025) vs. 2.4 million (2022)
• Key factor: Ontario’s “Safe Prescribing Framework” introduced real‑time alerts for high‑dose prescriptions.

British Columbia

• Prescriptions: 820,000 (2025) vs. 1.14 million (2022)
• Key factor: BC’s “enhanced Monitoring Program” mandated weekly reporting to the Provincial Pharmacy Database.

Quebec

• Prescriptions: 950,000 (2025) vs. 1.15 million (2022)
• Key factor: Quebec’s “Pain Management Partnerships” integrated pharmacists into primary‑care teams, reducing opioid initiation by 19 %.

Atlantic Provinces (NB, NS, PEI, NL)

• Combined prescriptions: 540,000 (2025) vs. 690,000 (2022)
• Key factor: Community‑based opioid‑reduction task forces focused on rural access to non‑opioid therapies.

impact on Opioid‑Related Harms

• Overdose deaths: Declined by 14 % (2022‑2025) according to the Public Health Agency of Canada.
• Hospital admissions for opioid poisoning: Fell from 9,800 (2022) to 7,200 (2025).
• Prescription‑related dependency diagnoses: Dropped by 18 % in primary‑care settings.

Practical Tips for Healthcare Professionals

1. Adopt evidence‑based prescribing limits – keep the daily morphine‑equivalent dose ≤ 90 mg unless justified.
2. Utilize provincial PDMPs before issuing any new opioid prescription.
3. Screen for risk factors (history of substance use disorder, mental health comorbidities) using the Opioid Risk Tool (ORT).
4. Offer multimodal pain plans at the first visit: NSAIDs, physical therapy, cognitive‑behavioral therapy, and, when appropriate, medical cannabis.
5. Schedule regular follow‑ups (minimum every 3 months) to reassess pain control and taper when feasible.

Benefits of Reduced Opioid Prescribing

• Improved public safety – fewer accidental overdoses and lower community availability of diverted opioids.
• Enhanced patient outcomes – patients report higher satisfaction with non‑opioid pain strategies (CIHI patient survey, 2025: 78 % satisfaction).
• Cost savings – Canada’s health system saved an estimated CAD $350 million in 2025 by reducing opioid‑related emergency visits and treatments.

Real‑World case Study: Vancouver’s “Opioid‑Free Pathways” Program

• Launch: March 2023, Vancouver Coastal Health Authority.
• Approach: Integrated care teams (physicians, pharmacists, addiction counselors) provided a step‑down protocol for chronic pain patients on high‑dose opioids.
• results (2024‑2025):
• 38 % reduction in average daily opioid dose among participants.
• 22 % decrease in opioid‑related ER visits.
• Patient‑reported pain scores remained stable (average 4.2/10 pre‑program vs. 4.3/10 post‑program).

Frequently Asked Questions (faqs)

Q1: Are opioids still prescribed for acute pain in Canada?

• Yes. Acute pain prescriptions follow the short‑course guideline (≤ 7 days, no refills) and remain a small proportion of total opioid use (< 12 %).

Q2: How does the decline affect patients with legitimate chronic pain needs?

• The Canadian Pain Society emphasizes individualized care; patients with severe, refractory pain can still access opioids through specialist referral and documented justification.

Q3: What resources are available for prescribers seeking training?

• Health Canada’s “Opioid Stewardship Hub” (online modules, webinars).
• Provincial College of Physicians – mandatory continuing medical education (CME) credits on opioid prescribing.

Monitoring Future Trends

• National Opioid Surveillance System (NOSS) to be fully operational by 2026, offering real‑time analytics on prescribing patterns.
• ongoing research by University of Toronto’s Centre for Addiction and Mental Health (CAMH) will evaluate the long‑term effects of the 2023 prescribing guidelines on pain management outcomes.

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