July 17, 2025
Disproportionately more opioids prescribed in poorer areas
Study finds triple the opioid prescriptions in lower-income areas compared to higher-income communities
Despite an overall decline in prescribed opioid use in Canada over the past decade, a recent study found that people in poorer areas receive three times the prescriptions for opioids than those in wealthier areas.
Researchers from the School of Pharmacy at the University of Waterloo analyzed prescription records in seven provinces’ public drug plans from 2010 to 2018, the most recent data available. British Columbia, Saskatchewan, and Manitoba shared comprehensive data across all age groups, and Alberta, Ontario, Newfoundland and Labrador, and Prince Edward Island provided data for individuals aged 65 and older. Quebec, New Brunswick, and Nova Scotia do not submit data to the federal entity that collects these records. The research team cross-referenced prescription patterns with census data on household income and sex to support their analysis.
Canada remains the world’s second-highest consumer of opioids. In 2024 alone, opioid-related harms averaged 67 emergency room visits, 99 emergency responses, 15 hospitalizations and 20 deaths per day, according to a report from the Government of Canada.
“Despite the perceived success in the reduction of opioid prescribing, inequalities persist,” said Dr. Wasem Alsabbagh, a professor in Waterloo’s School of Pharmacy. “Our findings confirm that among lower socio-economic areas, women overall receive more opioid prescriptions. Among men, those with lower incomes received more prescriptions than their counterparts in the higher income brackets.”
The research team, which also includes Dr. Susan Elliott, a professor in Waterloo's Faculty of Environment, says the gap in opioid use between communities raises important concerns, and the problem affects everyone. They hope the findings will inspire health-care providers to take additional steps towards mitigating the risks of opioid misuse and support more equitable care.
“Pharmacists are an essential part of the primary care team,” Alsabbagh said. “They can provide guidance to prescribers on individual prescriptions, appropriate dosages for each patient, inform policy decisions to address inequities and connect patients to support services, if necessary.”
Future research will expand on gathering more data from the private health-care sector to add to this research on prescribing patterns.
The study, Income-Based Disparities in Opioid Prescription Dispensing Among Public Drug Plan Beneficiaries in Canada from 2010 to 2018: A Population‑Based and Sex‑Stratified Retrospective Study, appears in Drugs Real World Outcomes.
