Academic journal article Canadian Journal of Public Health

Non-Medical Prescription Opioid Use, Prescription Opioid-Related Harms and Public Health in Canada: An Update 5 Years Later

Academic journal article Canadian Journal of Public Health

Non-Medical Prescription Opioid Use, Prescription Opioid-Related Harms and Public Health in Canada: An Update 5 Years Later

Article excerpt

Five years ago,1 several authors of the current paper published a commentary in this journal characterizing the emerging problem of non-medical prescription opioid use (NMPOU) and PO-related harms in Canada, and identifying crucial knowledge and intervention gaps, with particular relevance for public health. Half a decade later, it appears opportune to present a brief audit of the state of affairs and key developments since then on three fronts, namely: 1) key problem parameters, 2) key information gaps, and 3) interventions.

Compared with data presented in 2008, the problem of NMPOU has remained extensive; moreover, based on the data available, important harm outcomes in Canada have substantially increased. It ought to be noted, first, that annual PO consumption has almost doubled in Canada, from 16,628 defined daily doses (DDD) in 2004-2006 to 28,731 in 2009-2011, a steeper increase than in the United States, the country with the world's highest level of PO use.2 In Ontario, 6% of the adult population reported NMPOU (use in the past year) in 2010-2011, more than any illicit drug except cannabis; this rate is considerably higher among high-school students (15%-20%) as assessed by several recent surveys.3,4 Among street drug users, NMPOU remains highly prevalent,5 and key marginalized populations (e.g., First Nations or populations in correctional facilities) have demonstrated similarly high levels.6 PO-related morbidity and mortality outcomes have increased substantially. In Ontario, annual PO-related admissions to publicly funded centres for substance use treatment have doubled, from 10,564 in 2005-2006 to 21,448 in 2011-2012, and in the latter year constituted the third largest admissions category following alcohol, tobacco and cannabis.7 These numbers do not include admissions for opioid maintenance treatment, which have increased considerably because of problematic PO use.6 Similarly, opioid- related deaths in Ontario - virtually all of which (i.e., >90%) are PO-related - have almost tripled, from 187 in 2006 to 535 in 2011, accounting for higher death rates than all other illicit drugs combined and representing rates similar to those of motor vehicle accidents.8,9

The epidemiology of PO-related harms is mostly limited to Ontario-based indicator data, which are largely absent for the majority of other provinces. We commented in 2008 that key national PO-related problem indicator data would be needed for improved monitoring and surveillance. Unfortunately, little has materially changed or improved on this front. While the Canadian Alcohol and Drug Use Survey started to include PO-related questions in 2008, these items have used varying definitions with limited comparability with other surveys, e.g., the CAMH Monitor or the National Survey on Drug Use and Health in the US, and have not been analyzed regularly; this precludes (for exceptions, see Shield et al.10) systematic monitoring.11-13 Segments of PO-related morbidity or mortality data are sporadically available from other provinces, but national PO-related morbidity or mortality surveillance data - as are routinely accessible in the US and collected in Canada for other public health relevant diseases (e.g., cancer, HIV/AIDS) - are not currently available.14,15 Consequently, basic counts or trend analyses of the number of PO- related deaths in Canada remain unavailable, and cross-provincial analyses of differences in or possible determinants of PO-related mortality on a population level are impossible.

The issue of PO sourcing for NMPOU constitutes a further key knowledge gap. Although it is well established that sourcing involves a fairly large heterogeneity of pathways, a large proportion occurring by way of "informal sourcing" such as through family or friends, a comprehensive picture of mechanisms for NMPOU sourcing in Canada does not exist.9,16 Similarly, there are vast knowledge gaps with regard to evidence-based treatment practice for those presenting with PO-dependence. …

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