Differences in Opioid Prescribing by Urban and Rural Pharmacists in Nova Scotia, Canada—A Time Series Analysis from 2018 to 2022

During the COVID-19 pandemic, Health Canada temporarily exempted pharmacists from specific restrictions under the Controlled Drugs and Substances Act (CDSA), allowing them to prescribe opioids. However, it is not yet established whether opioid dispensing patterns differ between urban and rural pharmacists. This study aims to assess the impact of the CDSA subsection 56(1) temporary exemption on opioid prescribing practices among urban and rural pharmacists between 1 February 2018 and 30 April 2022. Descriptive statistics and visualizations assessed differences in opioid prescribing between urban and rural pharmacists under the CDSA exemption. Initial analyses employed linear regression to examine changes, followed by evaluation of temporal dependence using autocorrelation and residual analysis. When appropriate, a suitable time series model was subsequently applied. Following the CDSA exemption, the mean weekly proportion of opioid claims prescribed by urban pharmacists increased from 0.0% to 1.03%. In contrast, rural pharmacists’ prescriptions rose from 0.0% to 0.35%. The estimated mean level change was 0.667% for urban pharmacists (95% CI: 0.520–0.838%, p < 0.0001) and 0.201% for rural pharmacists (95% CI: 0.140–0.291%, p < 0.0001). The study identified distinct differences in opioid prescribing practices between urban and rural pharmacists in Nova Scotia. Furthermore, opioid prescriptions increased steadily across all patient groups, indicating evolving patterns of opioid use within the province.