Evidence map›Paper›PMID 40355138›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2025

The effects of a provincial opioid prescribing standard on prescribing for pain in adults: an interrupted time-series analysis.

Dimitra Panagiotoglou, Sandra Peterson, M Ruth Lavergne, Tara Gomes, Rashmi Chadha, Philippa Hawley, Rita McCracken

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Collateral harms following opioid prescribing standard.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Dimitra PanagiotoglouDepartment of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC. dimitra.panagiotoglou@mcgill.ca.
Sandra PetersonDepartment of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC.
M Ruth LavergneDepartment of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC.
Tara GomesDepartment of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC.
Rashmi ChadhaDepartment of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC.
Philippa HawleyDepartment of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC.
Rita McCrackenDepartment of Epidemiology, Biostatistics and Occupational Health (Panagiotoglou), McGill University, Montréal, Que.; Centre for Health Services and Policy Research (Peterson), University of British Columbia, Vancouver, BC; Department of Family Medicine, Faculty of Medicine (Lavergne), Dalhousie University, Halifax, NS; Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Vancouver Coastal Health Authority (Chadha); Department of Family Practice (Chadha, McCracken), University of British Columbia; BC Cancer Vancouver Centre and Division of Palliative Medicine, Department of Medicine (Hawley), University of British Columbia, Vancouver, BC.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn 2016, the College of Physicians and Surgeons of British Columbia released a legally enforceable opioid prescribing practice standard for the treatment of chronic noncancer pain (CNCP); it was revised in 2018 in response to concerns that it was misinterpreted. We aimed to test the effects of the practice standard on access to opioids for people treated for CNCP, living with cancer, or receiving palliative care.

methodsWe used comprehensive administrative health data from Oct. 1, 2012, to Mar. 31, 2020, and multiple baseline interrupted time-series analysis to evaluate the effects of the 2016 practice standard and 2018 revision in cohorts of people treated for CNCP, living with cancer, or receiving palliative care.

resultsThe 2016 practice standard accelerated pre-existing monthly trends in morphine milligram equivalents (MME) dispensed per person treated for CNCP (-0.1%, 95% confidence interval [CI] -0.2% to 0.0%), but also for people living with cancer (-0.7%, 95% CI -1.0% to -0.5%) and those receiving palliative care (-0.3%, 95% CI -0.5% to 0.0%). The proportion of people with CNCP prescribed a daily dose greater than 90 MME (-0.3%, 95% CI -0.4% to -0.2%), coprescribed a benzodiazepine or other hypnotic (-0.6%, 95% CI -0.7% to -0.5%), and aggressively tapered (-0.1%, 95% CI -0.2% to 0.0%) also decreased more quickly after the practice standard. Although we observed null or decreases in level effects overall, the proportion of people aggressively tapered increased 2.0% (95% CI 0.4% to 3.3%) immediately after implementation of the practice standard. Trends slowed or reversed after the 2018 revision.

interpretationThe 2016 practice standard was associated with an immediate and long-lasting effect on physicians' opioid prescribing behaviours, including inadvertently increasing aggressive tapering (observed level effect) and reducing access to opioids for people living with cancer or receiving palliative care.

Indexed as

Analgesics, OpioidChronic PainDrug PrescriptionsPractice Patterns, Physicians'AdultAgedBritish ColumbiaFemaleHumansInterrupted Time Series AnalysisMaleMiddle AgedNeoplasmsPalliative CarePractice Guidelines as TopicAnalgesics, Opioid

Identifiers

PMID40355138
PMCPMC12077321

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.