Why has the Opioid Crisis Remained Unchanged in Canada? The Limits of Bio-Scientific Based Policy Approaches

Ning, Ana; Csiernik, Rick

doi:10.1080/1533256x.2022.2071822

Cited by 2 publications

(3 citation statements)

References 39 publications

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“…The opioid crisis remains a significant public health challenge in Canada ( 13 ). Canada has one of the highest per capita consumptions of prescription opioids worldwide ( 48 , 49 ).…”

Section: Methodsmentioning

confidence: 99%

“…During the COVID-19 pandemic, this problem has become particularly acute, with sharp rises in death rates of opioid overdose ( 10 , 11 ) and destabilizing effects in prescription opioids ( 12 ). Undeniably, the opioid crisis continues unmitigated in Canada ( 13 ); therefore, ensuring the safety of opioid use and adequate access to pain management should be among the top priorities for the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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“…The opioid crisis remains a significant public health challenge in Canada ( 13 ). Canada has one of the highest per capita consumptions of prescription opioids worldwide ( 48 , 49 ).…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

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

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“…tramadol, codeine) is a global health problem (Brady et al , 2016; Volkow et al , 2019). In North American countries such as Canada and the USA, evidence has shown a persistent opioid overdose crisis, characterized by an exceptionally large number of deaths due to overdose on illicitly manufactured opioids (Humphreys et al , 2022; Martins et al , 2015; Ning and Csiernik, 2022). In the USA, the crisis was initially caused by over-prescribing of opioid analgesics, often with little consideration of patients’ medical needs (Beletsky and Davis, 2017).…”

Section: Introductionmentioning

confidence: 99%

Tramadol regulation, illegal markets and consumption practices: exploring frictions of drug control in Nigeria

Nelson

Odeigah²,

Dumbili

2023

DHS

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Purpose The purpose of this study is to understand the complex interplay between illicit opioids trade and consumption practices and state policies that aim to reduce their misuse. Design/methodology/approach The study adopted an exploratory design. Data were gathered through in-depth interviews with 31 commercially oriented drug dealers in Uyo, Nigeria. The framework approach was used in data analyses, while “friction” provided the interpretive lens. Findings Accounts revealed public concerns over the misuse of tramadol and other opioids among young people and the associated health and social harms. These concerns provided support for enforcement-based approaches to prescription opioids control, including police raids on pharmacy stores. These measures did not curtail opioids supply and consumption. Instead, they constrained access to essential medicines for pain management, encouraged illegal markets and fuelled law enforcement corruption in the form of police complicity in illegal tramadol trade. Research limitations/implications The findings reveal the frictions of drug control in Nigeria, wherein enforcement-based approaches gained traction through public concerns about opioids misuse but also faced resistance due to the persistence of non-medical use and illegal supply channels made possible by law enforcement complicity. These indicate a need to prioritize approaches that seek to reduce illegal supply and misuse of opioids while ensuring availability of these medications for health-care needs. Originality/value The study is unique in its focus on the creative tension that exists between state control measures and local opioids supply and consumption practices.

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Why has the Opioid Crisis Remained Unchanged in Canada? The Limits of Bio-Scientific Based Policy Approaches

Cited by 2 publications

References 39 publications

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

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

Tramadol regulation, illegal markets and consumption practices: exploring frictions of drug control in Nigeria

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