• Fahima Dossa, Kelly Metcalfe, Rinku Sutradhar, Tari Little, Andrea Eisen, Kathy Chun, Wendy S Meschino, Lea Velsher, Jordan Lerner Ellis, and Nancy N Baxter.
• Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia.
• CMAJ Open. 2020 Oct 1; 8 (4): E874-E885.

BackgroundThe College of Physicians and Surgeons of British Columbia introduced opioid prescribing standards and guidelines in mid-2016 in British Columbia. We evaluated impacts of the standards and guidelines on health outcomes.MethodsWe conducted a longitudinal study with repeated measures using administrative data from December 2013 to March 2017. The study included BC patients with long-term use of prescription opioids. Those with a history of long-term care, palliative care or cancer were excluded. Patients were followed for a 12-month prepolicy period and 10-month postpolicy period and compared with historical controls. We estimated changes in level (sudden changes) and monthly trend (gradual changes) of rates of opioid overdose hospital admission, and secondary outcomes of all-cause hospital admission, all-cause emergency department visits, opioid overdose mortality and all-cause mortality.ResultsThe study included 68 113 patients in the main cohort and 68 429 historical controls. We did not find significant changes to opioid overdose hospital admissions in level (adjusted rate ratio [RR] 0.83, 95% confidence interval [CI] 0.45-1.54) or in trend (adjusted RR 1.00, 95% CI 0.91-1.10). All-cause hospital admissions declined in level but may have increased in trend, suggesting that a temporary decrease in hospital admissions may have occurred. We found no significant changes in all-cause emergency department visits, opioid overdose mortality or all-cause mortality.InterpretationAmong patients with a history of long-term prescription opioid use, the regulatory prescribing standards and guidelines were not associated with changes in opioid overdose hospital admissions, all-cause emergency department visits, opioid overdose mortality or all-cause mortality, or with a sustained reduction in all-cause hospital admissions, over a 10-month period after they were introduced. Future research should investigate whether opioid prescribing standards or guidelines are associated with use of nonopioid analgesic medications or nonpharmacologic treatments.Copyright 2020, Joule Inc. or its licensors.

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