Patterns and history of prescription drug use among opioid-related drug overdose cases in British Columbia, Canada, 2015–2016

Cohort profile: development and characteristics of a retrospective cohort of individuals dispensed prescription opioids for non-cancer pain in British Columbia, Canada

“…Low-dose codeine formulations (<30 mg per tablet), PO formulations primarily used for cough suppression or opioid agonist therapy (OAT) and injectable PO formulations were not included in our eligibility criteria. 30 To limit the cohort to PO use for non-cancer pain, we also excluded all PO dispensations occurring after a cancer or palliative care diagnosis (online supplemental table 2).…”

“…Long-term episodes that did not meet the chronic definition were classified as episodic. The 50% episode intensity threshold is one of the cut-offs used by other research teams in BC to characterise long-term episodes (<20%=occasional, 20%-49%=regular/intermittent, 50%-89%=chronic, ≥90%=every day) 30 31 and was empirically derived (represents the median value for long-term episodes with ≥90 days' supply). 31 It also agrees with the US CDC's (Centers for Disease Control and Prevention) definition of long-term PO therapy (ie, 'use of opioids on most days for >3 months').…”

The North American Overdose Crisis and the European-American “Fentanyl and Treatment Gap”

“…Another noted explanation is the development of prescription opioid crisis in the early 2000s in the USA [28], which may contribute to the emergence of the current overdose crisis. However, a recent analysis of approximately 10,000 overdose cases in British Columbia in 2015-2016 failed to show a strong role for prescription opioids in the current overdose crisis but this may not be the case in other jurisdictions [29].…”

Psychiatry and the Opioid Crisis in Canada

“…Overall, opioid users who overdose are three to four times more likely to have a comorbid mental disorder (excluding other substance use disorders) compared to matched individuals with no overdose. 16 This is not surprising, given the overlapping mechanisms of substance use disorders and other mental disorders as well as the frequent convergence of signs and symptoms of these conditions. 17,18 This highlights the importance of assessment for psychiatric comorbidity in patients with opioid use disorder in order to identify individuals at substantially elevated mortality risk and to enable a personalized approach to their care.…”

“…En général, les utilisateurs d’opioïdes qui font une surdose sont 3 à 4 fois plus susceptibles d’avoir un trouble mental comorbide (à l’exception d’autres troubles d’utilisation de substances) comparativement à des personnes appariées n’ayant pas fait de surdose 16 . Cela n’a rien d’étonnant étant donné le chevauchement des mécanismes des troubles d’utilisation de substances et d’autres troubles mentaux ainsi que la convergence fréquente des signes et symptômes de ces affections 17,18 .…”