Confronting an Epidemic: Canada’s Response to the Opioid Crisis

Canadians from all walks of life have been profoundly impacted by the effects of problematic opioid use, and the crisis continues to claim lives at an alarming rate. By making investments in targeted, priority-driven research, CIHR can mobilize researchers to confront threats such as the opioid crisis, increasing awareness of the issue and our capacity to respond.

Through the Opioid Crisis Knowledge Synthesis operating grant, CIHR is supporting efforts to address the most urgent elements of the crisis, and to investigate strategies that could reduce opioid-related mortality rates.

A partnership with the Canadian Drugs and Substances Strategy, the CIHR Institute of Neurosciences, Mental Health and Addiction (CIHR-INMHA) and the CIHR Institute of Health Services and Policy Research (CIHR-IHSPR), has invested over $1.8 million to support 22 projects, matching teams of researchers with knowledge users across Canada.

Dr. Joshua A Rash, Memorial University of Newfoundland: Healthcare provider knowledge, attitudes, beliefs and practices around prescribing opioids to manage chronic non-cancer pain

Opioids analgesics can improve pain and function for many patients, but the decision to prescribe is complicated, and not without risk. Clinical practice guidelines help healthcare providers and their patients decide when potential benefits outweigh possible risks. Dr. Josh Rash collaborated with researchers, patients, and policy-makers from across Canada to examine 96 studies reporting on the knowledge, attitudes and beliefs of nearly 18,500 healthcare providers to see how these factors affect opioid prescribing practices. They observed that regulated professionals follow treatment guidelines with their patients in approximately 50% of interactions. Reasons for deviating from recommendations range from concerns surrounding potential misuse and other side effects, diversion of medication, regulatory scrutiny, and practitioner concerns in implementing complex recommendations. Interventions that target provider beliefs, and provide education and practical tools show improved adherence to clinical practice guidelines.

Drs. Corinne M Hohl and Jessica Moe, University of British Columbia: Naloxone Dosing in the Era of Ultra-Potent Opioid Overdoses

Dr. Jessica Moe
Vancouver General & BC Children's Hospital
Assistant Professor, UBC

Dr. Corinne Hohl
Vancouver General & BC Children's Hospital
Associate Professor, UBC

Drs. Corinne Hohl and Jessica Moe and their team at the University of British Columbia wanted to better understand the effectiveness of the opioid antidote naloxone on reversing overdoses due to increasingly common ultra-potent opioids such as fentanyl. They analyzed 174 studies that looked at naloxone administration to reverse non-medical opioid toxicity among 26,660 patients. They compared the dose of naloxone needed to reverse the effects of lower potency opiates such as morphine and heroin, compared to high-potency opioids. They determined that in North America, standard naloxone doses were less effective at reversing overdoses of fentanyl and its powerful new analogues, and these agents required higher overall doses to reverse their effects compared to heroin and other opioids. The study could have important implications for the development of first-responder treatment guidelines in communities with a high prevalence of ultra-potent opioids.

Drs. Andrea Furlan and Nancy Carnide, Institute for Work & Health (Toronto): Informing an “All Hands on Deck” approach to the opioid crisis

Dr. Nancy Carnide
Associate Scientist
Institute for Work & Health
University of Toronto

Dr. Andrea Furlan
Associate Professor
Department of Medicine
University of Toronto

At the Institute for Work and Health in Toronto, Drs. Andrea Furlan, Nancy Carnide, and their team reviewed 51 studies from the past five years that looked at the effectiveness of different strategies to address the opioid crisis. They identified a number of prevention strategies demonstrating promise in addressing the crisis. These include the development of regulations, educational programs, and clinical practice strategies targeting a range of outcomes, including opioid prescribing patterns, problematic use, and opioid-related emergency department visits. Improved clinical practice strategies were also impactful for populations demonstrating opioid-seeking behaviours, but data on the effectiveness of these and other strategies for other high-risk subgroups is lacking in this recent literature. The authors suggest that these strategies could be considered to help tackle the opioid crisis under the prevention pillar of the Canadian Drugs and Substances Strategy. An insufficient number of studies prevented the researchers from recommending similar strategies to support the objectives of the treatment, harm reduction and enforcement pillars.

Date modified:

2019-03-20