Article

Characteristics of Opioid-Users Whose Death Was Related to Opioid-Toxicity: A Population-Based Study in Ontario, Canada

Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
PLoS ONE (Impact Factor: 3.53). 04/2013; 8(4):e60600. DOI: 10.1371/journal.pone.0060600
Source: PubMed

ABSTRACT The impact of the prescription opioid public health crisis has been illustrated by the dramatic increase in opioid-related deaths in North America. We aimed to identify patterns and characteristics amongst opioid-users whose cause of death was related to opioid toxicity.
This was a population-based study of Ontarians between the years 2006 and 2008. All drug-related deaths which occurred during this time frame were reviewed at the Office of the Chief Coroner of Ontario, and opioid-related deaths were identified. Medical, toxicology, pathology, and police reports were comprehensively reviewed. Narratives, semi-quantitative, and quantitative variables were extracted, tabulated, and analyzed.
Out of 2330 drug-related deaths in Ontario, 58% were attributed either in whole or in part, to opioids (n = 1359). Oxycodone was involved in approximately one-third of all opioid-related deaths. At least 7% of the entire cohort used opioids that were prescribed for friends and/or family, 19% inappropriately self-administered opioids (injection, inhalation, chewed patch), 3% were recently released from jail, and 5% had been switched from one opioid to another near the time of death. Accidental deaths were significantly associated with personal history of substance abuse, enrollment in methadone maintenance programs, cirrhosis, hepatitis, and cocaine use. Suicides were significantly associated with mental illness, previous suicide attempts, chronic pain, and a history of cancer. SIGNIFICANCECONCLUSION: These results identify novel, susceptible groups of opioid-users whose cause of death was related to opioids in Ontario and provide the first evidence to assist in quantifying the contribution of opioid misuse and diversion amongst opioid-related mortality in Canada. Multifaceted prevention strategies need to be developed based on subpopulations of opioid users.

Download full-text

Full-text

Available from: Parvaz Madadi, Aug 24, 2015
0 Followers
 · 
94 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prescription opioid analgesic (POA)-related harms constitute a major public health problem in North America. Ontario features above-average POA use levels in Canada and has seen consistent increases in related mortality and morbidity. Recent studies documented strong correlations between POA dispensing levels and related harm outcomes on population levels. We examined correlations between POA dispensing and key POA-related mortality and morbidity indicators in Ontario, 2005-2011. Correlations between (i) annual dispensing levels of four strong POA formulations (fentanyl, hydromorphone, morphine and oxycodone; from IMS Brogan's Compuscript converted to defined daily doses) and POA-related mortality (based on provincial coroner's data) and (ii) annual total POA dispensing and POA-related treatment caseload (from the Drug and Alcohol Treatment Information System) were examined for the study context. Strong and significant correlations were observed between POA dispensing and mortality for three formulations, namely hydromorphone: 0.98 [95% confidence interval (CI) 0.89-1.00; P < 0.001], fentanyl: 0.93 (95% CI 0.58-0.99; P = 0.003) and oxycodone: 0.93 (95% CI 0.57-0.99; P = 0.003), but not morphine (-0.29; 95% CI-0.86-0.59; P = 0.523), as well as for treatment when examining congruent years [0.99 (95% CI 0.92-1.00); P < 0.001] and when using a 1-year offset (1.00; 95% CI 0.96-1.00; P < 0.001). POA dispensing levels were found to be strongly correlated with mortality and morbidity (treatment) indicators. Targeted and sensible reductions of POA use level would likely constitute a primary measure to reduce POA-related harms on a population level, especially in a jurisdiction with high POA consumption levels. [Fischer B, Jones W, Urbanoski K, Skinner R, Rehm J. Correlations between prescription opioid analgesic dispensing levels and related mortality and morbidity in Ontario, Canada, 2005-2011. Drug Alcohol Rev 2013].
    Drug and Alcohol Review 11/2013; 33(1). DOI:10.1111/dar.12089 · 1.55 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. Canada features the world's second-highest POA consumption rates. Following increases in POA-related harm, several POA control interventions have been implemented since 2010. We examined trends and patterns in POA dispensing in Canada by province for 2005-2012, including a focus on the potential effects of interventions. Data on annual dispensing of individual POA formulations - categorized into 'weak opioids' and 'strong opioids' - from a representative sub-sample of 5,700 retail pharmacies across Canada (from IMS Brogan's Compuscript) were converted into Defined Daily Doses (DDD), and examined intra- and inter-provincially as well as for Canada (total). Total POA dispensing - driven by strong opioids - increased across Canada until 2011; four provinces indicated decreases in strong opioid dispensing; seven provinces indicated decreases specifically in oxycodone dispensing, 2011-2012. The dispensing ratio weak/strong opioids decreased substantively. Major inter-provincial differences in POA dispensing levels and qualitative patterns of POA formulations dispensed persisted. Previous increasing trends in POA dispensing were reversed in select provinces 2011-2012, coinciding with POA-related interventions. Further examinations regarding the sustained nature, drivers and consequences of the recent trend changes in POA dispensing - including possible 'substitution effects' for oxycodone reductions - are needed.
    BMC Health Services Research 02/2014; 14(1):90. DOI:10.1186/1472-6963-14-90 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to assess the relationship between genetic polymorphisms and drug interactions on codeine and morphine concentrations in codeine-related deaths (CRD). All CRD in Ontario, Canada between 2006 and 2008 were identified. Post-mortem blood was analyzed for 22 polymorphisms in 5 genes involved in codeine metabolism and response. Sixty-eight CRD were included in this study. The morphine-to-codeine ratio was significantly correlated with the presence of a CYP2D6 inhibitor at varying potencies (p=0.0011). The presence of other central nervous system (CNS) depressants (i.e. benzodiazepines, hypnotics, and/or alcohol) was significantly associated with lower codeine concentration as compared to CRD in which other CNS depressants were not detected (p=0.0002). Individuals who carried the ABCB1 1236T variant had significantly lower morphine concentrations (p=0.004). In this population of individuals whose cause of death was related to codeine, drug interactions and genetic polymorphisms were significantly associated with post-mortem codeine and morphine concentrations.
    Forensic science international 03/2014; 239C:50-56. DOI:10.1016/j.forsciint.2014.03.018 · 2.12 Impact Factor
Show more