Assessing the prevalence of non-medical prescription opioid use in the Canadian general adult population: evidence of large variation depending on survey questions used

Abstract

BackgroundMorbidity and mortality related to Prescription Opioid Analgesics (POAs) have been rising sharply in North America. Non-Medical Prescription Opioid Use (NMPOU) in the general population is a key indicator of POA-related harm, yet the role of question item design for best NMPOU prevalence estimates in general population surveys is unclear, and existing NMPOU survey data for Canada are limited.MethodsWe tested the impact of different NMPOU question items by comparing an item in the 2008 and 2009 (N = 2,017) samples of the CAMH Monitor surveys – an Ontario adult general population survey – with a newly developed item used in the 2010 (N = 2,015) samples of the Centre for Addiction and Mental Health (CAMH) Monitor surveys. To control for a potential difference in the population demographics between surveys, we adjusted for gender, age, region, income, prescription opioid use, cigarette smoking, weekly binge drinking, cannabis use in the past three months, and psychological distress in our analyses.ResultsThe prevalence of NMPOU as measured by the 2008 and 2009 CAMH monitor (2.0% [95% CI: 1.2% to 2.8%]) was significantly different when compared to the prevalence of NMPOU as measured by the 2010 CAMH monitor (7.7% [95% CI: 6.3% to 9.2%]) (p < 0.001). This difference was also found when stratifying our analysis by sex (p < 0.001) and when adjusting for all potential confounding covariates.ConclusionIt is highly unlikely that the extensive NMPOU prevalence differences observed from the different survey items reflect an actual increase of NMPOU or changes in NMPOU determinants, but rather point to measurement effects. It appears that we currently do not have accurate estimates of NMPOU in the Canadian general population, even though these estimates are needed to guide and implement targeted interventions. Given the current substantial morbidity and mortality impact of NMPOU, there is an urgent need to systematically develop, validate and standardize NMPOU items for future general population surveys in Canada.

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

“…It has been estimated that the harms from PO misuse in Canada now constitute the third highest overall substance use burden (after alcohol and tobacco) and that up to 1.25 million Canadians use POs for nonmedical purposes (Fischer & Rehm, 2011). There has been significant variation in the estimated prevalence of PO misuse among the general adult population in Canada; an updated 2010 survey in Ontario estimated the prevalence of nonmedical PO use (NPOU) to be as high as 7.7% (95% CI: 6.3% to 9.2%), while the 2008/2009 Centre for Addiction and Mental Health (CAMH) Monitor survey found NPOU to be much lower at 2.0% (95% CI: 1.2% to 2.8%) (Shield, Ialomiteanu, Fischer, & Rehm, 2013). Canada has seen PO-related deaths rise substantially; over a five-year period (1994-1999) oxycodone-related mortality in Ontario rose four fold ( p <0.01) (Dhalla, Mamdani, Gomes, & Juurlink, 2011).…”

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“…Le Prescription opioid use in Canada has tripled in the last decade, and Canada is the second largest consumer of opioids per capita in the world. 1,2 Approximately 20% of Canadians have been prescribed an opioid in the past year, and another 5% admit to using opioid medications that were not prescribed for them. 2 The rates of addiction, overdose, and death attributed to opioids doubled from 13.7 per million in 1991 to 27.2 per million in 2004.…”

“…1,2 Approximately 20% of Canadians have been prescribed an opioid in the past year, and another 5% admit to using opioid medications that were not prescribed for them. 2 The rates of addiction, overdose, and death attributed to opioids doubled from 13.7 per million in 1991 to 27.2 per million in 2004. 3 Unfortunately, non-medical prescription opioid use accounts for 40% of these overdoses.…”

“…3 Unfortunately, non-medical prescription opioid use accounts for 40% of these overdoses. 2 Opioids are an accepted important therapy in the management of post-surgical pain. Half of all surgical patients are discharged with opioid prescriptions, and 3-5% continue these medications beyond the expected duration of postoperative pain.…”

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“…However, it is not limited to the USA alone. Recently, it was reported that correlated to increasingly high overall prescription opioid consumption levels, nonmedical prescription opioid use and harms in Canada are high and now likely constitute the third highest level of substanceuse disease burden after alcohol and tobacco [11,20]. Similarly, prescription opioid analgesics and related harms in Australia have been reported [12].…”