Jani M, Girard N, Bates DW, et al. - Several high-income countries, especially North America, have been affected by an opioid crisis followed by a sharp rise in opioid-related deaths in recent years. Researchers herein compared opioid prescribing rates at international level and determined the disparities between countries in the type, strength, starting dose of opioids, and whether these characteristics change over time.

• In this retrospective multicenter cohort study, data from 2,542,890 adults who were prescribed opioids for the first time between 2006 to 2016 in 4 countries and 5 jurisdictions (United States, Boston; Canada, Quebec and Alberta; United Kingdom; Taiwan) were analyzed.

• In 2014, there were highest opioid prescribing rates in Alberta at 66/1,000 persons vs 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively, after standardizing for age and gender.

• Boston had the highest median morphine milligram equivalents (MMEs)/day at first use at 38 MME/day; followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11).

• The first prescribed opioid was oxycodone in 65% of patients of the US cohort compared with 14%, Quebec; 4%, Alberta; 0.1%, UK; and none in Taiwan.

• At initiation of an opioid, the US CDC–recommended threshold of 50 MME/day was exceeded in 20% of US patients, 13% of Quebec patients, and 10% of Albertans, compared with 0.6% in the UK and 0.2% in Taiwan.

• This is one of the first international comparisons on this topic suggesting the possible contributing role of the preference to initiate patients on higher MME/day and more potent opioids in North America, to the opioid epidemic.