Between a rock and a hard place: Prescription opioid restrictions in the time of fentanyl and other street drug adulterants

Cheng, Tessa; DeBeck, Kora

doi:10.17269/cjph.108.6075

Cited by 9 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 20 21 This information can be a crucial component of evidence informed policy responses that comprehensively address the roles that prescribers, pharmacists, harm reduction workers, and law enforcement can play in tackling the ongoing opioid crisis. 22 23 …”

Section: Introductionmentioning

confidence: 99%

Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada

Gomes

Khuu

Martins

et al. 2018

BMJ

125

116

View full text Add to dashboard Cite

ObjectiveTo describe the contributions of prescribed and non-prescribed opioids to opioid related deaths.DesignPopulation based cohort study.SettingOntario, Canada, from 1 January 2013 to 31 December 2016.ParticipantsAll Ontarians who died of an opioid related cause.ExposureActive opioid prescriptions, defined as those with a duration overlapping the date of death, and recent opioid prescriptions, defined as those dispensed in the 30 and 180 days preceding death. Postmortem toxicology results from the Drug and Drug/Alcohol Related Death database were used to characterise deaths on the basis of presence of prescribed and non-prescribed (that is, diverted or illicit) opioids, overall and stratified by year and age.Results2833 opioid related deaths occurred. An active opioid prescription on the date of death was relatively common but declined slightly throughout the study period (38.2% (241/631) in 2013 and 32.5% (278/855) in 2016; P for trend=0.03). Older people and women were relatively more likely to have an active opioid prescription at time of death. In 2016, 46% (169/364) of people aged 45-64 had an active opioid prescription compared with only 12% (8/69) among those aged 24 or younger (P for trend<0.001). Similarly, 46% (124/272) of women had an active opioid prescription at time of death compared with 26.4% (154/583) of men (P<0.001). Among people with active opioid prescriptions at time of death, 37.8% (375/993) also had evidence of a non-prescribed opioid on postmortem toxicology. By 2016, the non-prescribed opioid most commonly identified after death was fentanyl (41%; 47 of 115 cases). Among people without an active opioid prescription at time of death, fentanyl was detected in 20% (78/390) of deaths in 2013, increasing to 47.5% (274/577) by 2016 (P<0.001).ConclusionsPrescribed, diverted, and illicit opioids all play an important role in opioid related deaths. Although more than half of all opioid related deaths still involved prescription drugs (either dispensed or diverted) in 2016, the increased rate of deaths involving fentanyl between 2015 and 2016 is concerning and suggests the need for a multifactorial approach to this problem that considers both the prescribed and illicit opioid environments.

show abstract

Section: Introductionmentioning

confidence: 99%

Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada

Gomes

Khuu

Martins

et al. 2018

BMJ

125

116

View full text Add to dashboard Cite

show abstract

“…Indeed, the defined daily doses of opioids prescribed have decreased across most of Canada between 2012 and 2016 [20]. However, this action led some individuals who were taking opioids to manage their pain to access the illicit supply when their prescription was suddenly cut off [38]. Deprescribing increased the dangers to individuals taking substances that were not pharmaceutical grade, of unknown content and potency, and which could contain dangerous contaminants such as fentanyl and its analogues.…”

Section: Resultsmentioning

confidence: 99%

Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy

Taha

Maloney‐Hall

Buxton

2019

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

Background: Canada is facing an urgent challenge to reduce the harms associated with opioids: from January 2016 to December of 2018, more than 11,500 individuals lost their lives due to opioid related harms. This review examines responses to the opioid crisis thus far, the lessons learned from these initiatives and the knowledge gaps that still need to be addressed across the four pillar model adopted by the CDSS. Methods: A search of peer-reviewed literature was conducted in PubMed and PsycNet, and grey literature was retrieved from reputable substance use and health organizations to determine responses to the opioid crisis and related outcomes between 2013 and 2019. Findings related to actions, outcomes and unintended consequences across the categories of prevention, treatment, harm reduction, enforcement and the evidence base were included and synthesized into a narrative review on lessons learned. Results: The opioid crisis is a result of multiple, complex interrelated factors. Many physicians may not feel competent to appropriately treat pain and/or addiction. Pushes for opioid deprescribing have resulted in some individuals using illicit opioids as treatment. A range of effective and accessible pharmacological and psychological treatments are still required. When regulations are barriers, unsanctioned actions, such as overdose prevention sites, may be enacted by individuals to respond to urgent public health needs. A nimble response with evolving enforcement perspectives can aid individuals experiencing harms from opioid use. Conclusions: There is no one size fits all response to this crisis, and consideration should be given to the unique needs of different communities and populations, as well as the broader impact of harms on families, communities, and society. A situation so multifaceted requires both immediate and long-term strategies implemented concurrently in order to address the differing and ongoing needs of Canadians experiencing opioid harms. The expertise of individuals and families affected by the opioid crisis must be included in consultations and decisions related to different strategies, to ensure responses are not stigmatizing, that they will be effective and acceptable and that unintended consequences are quickly recognized and mitigated.

show abstract

“…An estimated 8%–12% of patients who were prescribed with these medications developed dependence and started obtaining additional prescription opioids from different means such as overlapping opioid prescriptions, feigning symptoms of pain, or borrowing from other patients ( 7 , 8 ). The quest to use increasing quantities may shift patients to street opioids ( 51 ). Potential shifts in opioid utilization and provision may lead to a move toward stronger illicit resources, beginning with heroin and possibly escalating to fentanyl ( 52 , 53 ), to the extent that the prevalence of synthetic opioids like fentanyl in street opioids is responsible for 80% of all opioid-related deaths recorded in Canada in 2021 ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

Opioid-related harms and care impacts of conventional and AI-based prescription management strategies: insights from leveraging agent-based modeling and machine learning

Shojaati

Osgood

2023

Front. Digit. Health

View full text Add to dashboard Cite

IntroductionLike its counterpart to the south, Canada ranks among the top five countries with the highest rates of opioid prescriptions. With many suffering from opioid use disorder first having encountered opioids via prescription routes, practitioners and health systems have an enduring need to identify and effectively respond to the problematic use of opioid prescription. There are strong challenges to successfully addressing this need: importantly, the patterns of prescription fulfillment that signal opioid abuse can be subtle and difficult to recognize, and overzealous enforcement can deprive those with legitimate pain management needs the appropriate care. Moreover, injudicious responses risk shifting those suffering from early-stage abuse of prescribed opioids to illicitly sourced street alternatives, whose varying dosage, availability, and the risk of adulteration can pose grave health risks.MethodsThis study employs a dynamic modeling and simulation to evaluate the effectiveness of prescription regimes employing machine learning monitoring programs to identify the patients who are at risk of opioid abuse while being treated with prescribed opioids. To this end, an agent-based model was developed and implemented to examine the effect of reduced prescribing and prescription drug monitoring programs on overdose and escalation to street opioids among patients, and on the legitimacy of fulfillments of opioid prescriptions over a 5-year time horizon. A study released by the Canadian Institute for Health Information was used to estimate the parameter values and assist in the validation of the existing agent-based model.Results and discussionThe model estimates that lowering the prescription doses exerted the most favorable impact on the outcomes of interest over 5 years with a minimum burden on patients with a legitimate need for pharmaceutical opioids. The accurate conclusion about the impact of public health interventions requires a comprehensive set of outcomes to test their multi-dimensional effects, as utilized in this research. Finally, combining machine learning and agent-based modeling can provide significant advantages, particularly when using the latter to gain insights into the long-term effects and dynamic circumstances of the former.

show abstract

Between a rock and a hard place: Prescription opioid restrictions in the time of fentanyl and other street drug adulterants

Cited by 9 publications

References 13 publications

Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada

Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada

Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy

Opioid-related harms and care impacts of conventional and AI-based prescription management strategies: insights from leveraging agent-based modeling and machine learning

Contact Info

Product

Resources

About