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Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: A multi-jurisdictional cross-sectional study.
Drug Alcohol Depend. 2018 10 01; 191:86-90.DA

Abstract

BACKGROUND

The Canadian opioid crisis is a complex, multifaceted problem involving prescribed, diverted and illicitly manufactured opioids. This study sought to characterize the contribution of prescribed opioids to opioid-related hospitalizations in Canada.

METHODS

We conducted a cross-sectional study of all individuals who were admitted to hospital for opioid toxicity in British Columbia (BC), Manitoba and Ontario between April 2015 and March 2016. We used prescription claims to ascertain active prescription opioid use at time of hospital admission. In secondary analyses, we defined recent opioid prescriptions as those that were dispensed in the 30 and 180 days up to and including admission, and the prevalence of active co-prescription of benzodiazepines with opioids at time of overdose.

RESULTS

We identified 2599 instances of opioid toxicity over the study period. In BC, 34.1% of hospital visits for overdose occurred in people with an active opioid prescription, compared to 52.2% (47 of 90) in Manitoba and 52.8% (804 of 1524) in Ontario. However, active opioid prescriptions prior to overdose varied significantly by age and sex. Co-prescription of opioids and benzodiazepines prior to overdose ranged from 17.1% in BC to 35.6% in Manitoba.

CONCLUSIONS

There remains an important ongoing contribution of prescribed opioids to overdoses across Canada, but non-prescribed opioids play a growing role, particularly in BC. These findings underscore the importance of more judicious opioid prescribing, harm reduction programs, and improved access to addiction care for people with an opioid use disorder.

Authors+Show Affiliations

Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario M5S 3M2, Canada. Electronic address: GomesT@smh.ca.Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.The Canadian Institute for Health Information, 4110 Yonge St, North York, Ontario M2P 2B7, Canada.Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.The Canadian Institute for Health Information, 4110 Yonge St, North York, Ontario M2P 2B7, Canada.The Canadian Institute for Health Information, 4110 Yonge St, North York, Ontario M2P 2B7, Canada.Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario M5S 3M2, Canada.Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario M5S 3M2, Canada.Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario L8P 1H6, Canada.Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Department of Medicine at the University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, Ontario M5S 1A8, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30096638

Citation

Gomes, Tara, et al. "Comparing the Contribution of Prescribed Opioids to Opioid-related Hospitalizations Across Canada: a Multi-jurisdictional Cross-sectional Study." Drug and Alcohol Dependence, vol. 191, 2018, pp. 86-90.
Gomes T, Khuu W, Craiovan D, et al. Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: A multi-jurisdictional cross-sectional study. Drug Alcohol Depend. 2018;191:86-90.
Gomes, T., Khuu, W., Craiovan, D., Martins, D., Hunt, J., Lee, K., Tadrous, M., Mamdani, M. M., Paterson, J. M., & Juurlink, D. N. (2018). Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: A multi-jurisdictional cross-sectional study. Drug and Alcohol Dependence, 191, 86-90. https://doi.org/10.1016/j.drugalcdep.2018.06.028
Gomes T, et al. Comparing the Contribution of Prescribed Opioids to Opioid-related Hospitalizations Across Canada: a Multi-jurisdictional Cross-sectional Study. Drug Alcohol Depend. 2018 10 1;191:86-90. PubMed PMID: 30096638.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: A multi-jurisdictional cross-sectional study. AU - Gomes,Tara, AU - Khuu,Wayne, AU - Craiovan,Diana, AU - Martins,Diana, AU - Hunt,Jordan, AU - Lee,Kathy, AU - Tadrous,Mina, AU - Mamdani,Muhammad M, AU - Paterson,J Michael, AU - Juurlink,David N, Y1 - 2018/07/31/ PY - 2018/03/21/received PY - 2018/06/11/revised PY - 2018/06/16/accepted PY - 2018/8/11/pubmed PY - 2018/12/12/medline PY - 2018/8/11/entrez KW - Illicit drugs KW - Opioids KW - Pharmacoepidemiology SP - 86 EP - 90 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 191 N2 - BACKGROUND: The Canadian opioid crisis is a complex, multifaceted problem involving prescribed, diverted and illicitly manufactured opioids. This study sought to characterize the contribution of prescribed opioids to opioid-related hospitalizations in Canada. METHODS: We conducted a cross-sectional study of all individuals who were admitted to hospital for opioid toxicity in British Columbia (BC), Manitoba and Ontario between April 2015 and March 2016. We used prescription claims to ascertain active prescription opioid use at time of hospital admission. In secondary analyses, we defined recent opioid prescriptions as those that were dispensed in the 30 and 180 days up to and including admission, and the prevalence of active co-prescription of benzodiazepines with opioids at time of overdose. RESULTS: We identified 2599 instances of opioid toxicity over the study period. In BC, 34.1% of hospital visits for overdose occurred in people with an active opioid prescription, compared to 52.2% (47 of 90) in Manitoba and 52.8% (804 of 1524) in Ontario. However, active opioid prescriptions prior to overdose varied significantly by age and sex. Co-prescription of opioids and benzodiazepines prior to overdose ranged from 17.1% in BC to 35.6% in Manitoba. CONCLUSIONS: There remains an important ongoing contribution of prescribed opioids to overdoses across Canada, but non-prescribed opioids play a growing role, particularly in BC. These findings underscore the importance of more judicious opioid prescribing, harm reduction programs, and improved access to addiction care for people with an opioid use disorder. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/30096638/Comparing_the_contribution_of_prescribed_opioids_to_opioid_related_hospitalizations_across_Canada:_A_multi_jurisdictional_cross_sectional_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(18)30392-2 DB - PRIME DP - Unbound Medicine ER -