Association for Public Policy Analysis & Management

Canada and the United States have the highest prescription opioid consumption per capita in the world, which historically was attributed to widespread overprescribing of this class of medications for decades. In parallel with increasing opioid prescribing, rates of opioid-related overdoses climbed across North America, leading to many characterizing the opioid-related harms as the most important public health issue of our time. However, as the policy and clinical response to this issue has evolved over the past decade, so have the drivers of this epidemic. In particular, as prescription opioids become more difficult to access, several provinces across Canada have demonstrated rising rates of fatal overdoses from illicitly manufactured opioids, such as fentanyl and its analogues. This presentation will review patterns of opioid prescribing and related harms, and how these have been impacted by shifting policies, drug availability, and prescribing guidelines. Furthermore, it will present the results of evaluations of recently introduced policies designed to address this issue, focusing both on intended and unintended consequences. Finally, the implications of the shifting opioid environment will be discussed, along with suggestions for how future policies and responses to this issue can be designed to effect positive change.