The opioid death crisis in Canada: crucial lessons for public health

Fischer, Benedikt; Pang, Michelle; Tyndall, Mark

doi:10.1016/s2468-2667(18)30232-9

“…The situation is just as dire in Canada, which saw a corresponding 4,100 fatal overdoses that same year (11.2 per 100,000 population; Special Advisory Committee on the Epidemic of Opioid Overdoses, 2019). But while both nations refer to the opioid crisis as a public health emergency (Health Canada, 2019;Ending America's Opioid Crisis, 2019), concrete actions towards harm reduction and treatment options have been limited (Casey, 2016;CFMS, 2018;GAO, 2018;Warren, 2018;Fischer et al, 2019;Frank and Haffajee, 2019). Moreover, public opinion remains divided about important aspects of the opioid crisis, with opinion leaders reporting conflicting views about the severity of the situation, how best to respond to it, and who is responsible (Nanos Research, 2017;American Psychiatric Association, 2018;Angus Reid Institute, 2018;Blendon and Benson, 2018;Manchikanti et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Framing science: How opioid research is presented in online news media

Matthias¹,

Fleerackers²,

Alperin³

2019

Preprint

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Popular news media play an instrumental role in shaping public perception of issues like the opioid crisis. Using a detailed coding instrument, we analyzed how opioid-related research was covered in 151 news stories published by nine major US and Canadian online news outlets at the height of the crisis. We find that a small proportion of available research receives coverage, mostly within issuefocused rather than science communication news stories. While most research studies are framed as established "facts", stories rarely provide sufficient information for news consumers to critically evaluate the validity of the research. Potential implications for science communication and public perception of science are discussed. www.scholcommlab.ca

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“…This provided crucial insight for guiding opioid policy and medical practice control (e.g., prescription guidance) in the distinct contexts of traditionally high opioid availability in North America, combined with evidence of only limited effectiveness of opioids for chronic pain therapy [51][52][53]. Beyond these current contexts, where illicitly produced opioids have increasingly replaced pharmaceutical-grade opioids for non-medical use, these insights may be helpful for settings where opioid availability is still low and preventive restraints can facilitate appropriate balance between opioid availability and related adverse health outcomes [5,38,54,55]. As a potentially relevant limitation for the present analyses, we note that the (general population-level) data examined did not include additional patient-level descriptors, or other data variables that could have been used to examine possibly confounding factors in the correlations assessed.…”

Section: Resultsmentioning

confidence: 99%

Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007 - 2016

Jones

¹

,

Kurdyak

²

,

Fischer

³

2020

Preprint

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0

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Background: High levels of opioid-related mortality, as well as morbidity, contribute to the excessive opioid-related disease burden in North America, induced by high availability of opioids. While correlations between opioid dispensing levels and mortality outcomes are well-established, fewer evidence exists on correlations with morbidity (e.g., hospitalizations).Methods: We examined possible overtime correlations between medical opioid dispensing and opioid-related hospitalizations in Canada, by province, 2007 – 2016. For dispensing, we examined annual volumes of medical opioid dispensing from a representative, stratified sample of retail pharmacies across Canada. Raw dispensing information for ‘strong opioids’ was converted into Defined Daily Doses per 1,000 population per day (DDD/1,000/day). Opioid-related hospitalization rates referred to opioid poisoning-related admissions by province, for fiscal years 2007-08 to 2016-17, drawn from the national Hospital Morbidity Database. We assessed possible correlations between opioid dispensing and hospitalizations by province using the Pearson product moment correlation; correlation values (r) and confidence intervals were reported.Results: Significant correlations for overtime correlations between population-levels of opioid dispensing and opioid-related hospitalizations were observed for three provinces: Quebec (r=0.87, CI: 0.49–0.97; p=0.002); New Brunswick (r=0.85;CI: 0.43–0.97; p=0.004) and Nova Scotia (r=0.78; CI:0.25–0.95; p=0.012), with Saskatchewan (r=0.073; CI:-0.07–0.91;p=0.073) featuring borderline significance.Conclusions: The correlations observed further contribute to evidence on opioid dispensing levels as a systemic driver of population-level harms. Notably, correlations were not identified principally in provinces with reported high contribution levels (>50%) of illicit opioids to mortality, which are not captured by dispensing data and so may have distorted potential effects due to contamination.

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“…This provided crucial insight for guiding opioid policy and medical practice control (e.g., prescription guidance) in the distinct contexts of traditionally high opioid availability in North America, combined with evidence of only limited effectiveness of opioids for chronic pain therapy [51][52][53]. Beyond these current contexts, where illicitly produced opioids have increasingly replaced pharmaceutical-grade opioids for non-medical use, these insights may be helpful for settings where opioid availability is still low and preventive restraints can facilitate appropriate balance between opioid availability and related adverse health outcomes [5,38,54,55].…”

Section: Discussionmentioning

confidence: 99%

Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007 - 2016

Jones

¹

,

Kurdyak

²

,

Fischer

³

2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: High levels of opioid-related mortality, as well as morbidity, contribute to the excessive opioid-related disease burden in North America, induced by high availability of opioids. While correlations between opioid dispensing levels and mortality outcomes are well-established, fewer evidence exists on correlations with morbidity (e.g., hospitalizations).Methods: We examined possible overtime correlations between medical opioid dispensing and opioid-related hospitalizations in Canada, by province, 2007 – 2016. For dispensing, we examined annual volumes of medical opioid dispensing from a representative, stratified sample of retail pharmacies across Canada. Raw dispensing information for ‘strong opioids’ was converted into Defined Daily Doses per 1,000 population per day (DDD/1,000/day). Opioid-related hospitalization rates referred to opioid poisoning-related admissions by province, for fiscal years 2007-08 to 2016-17, drawn from the national Hospital Morbidity Database. We assessed possible correlations between opioid dispensing and hospitalizations by province using the Pearson product moment correlation; correlation values (r) and confidence intervals were reported.Results: Significant correlations for overtime correlations between population-levels of opioid dispensing and opioid-related hospitalizations were observed for three provinces: Quebec (r=0.87, CI: 0.49–0.97; p=0.002); New Brunswick (r=0.85;CI: 0.43–0.97; p=0.004) and Nova Scotia (r=0.78; CI:0.25–0.95; p=0.012), with Saskatchewan (r=0.073; CI:-0.07–0.91;p=0.073) featuring borderline significance.Conclusions: The correlations observed further contribute to evidence on opioid dispensing levels as a systemic driver of population-level harms. Notably, correlations were not identified principally in provinces with reported high contribution levels (>50%) of illicit opioids to mortality, which are not captured by dispensing data and so may have distorted potential effects due to contamination.

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The opioid death crisis in Canada: crucial lessons for public health

Cited by 101 publications

References 5 publications

Framing science: How opioid research is presented in online news media

Framing science: How opioid research is presented in online news media

Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007 - 2016

Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007 - 2016

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