At-a-glance - Hospitalizations and emergency department visits due to opioid poisoning in Canada

O'Connor, Shannon M.; Grywacheski, Vera; Louie, Krista

doi:10.24095/hpcdp.38.6.04

Cited by 34 publications

(33 citation statements)

References 5 publications

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“…Other studies may include ICD codes not referenced in the present study. 37 The actual burden of disability associated with a broader range of opioid use is likely to be higher than the estimates reported here. Disability weights derived from surveys in a limited number of countries may not be entirely applicable to the Canadian context, and the underlying level of disability for opioid use disorder may vary significantly over time and between contexts.…”

Section: Strengths and Limitationsmentioning

confidence: 60%

Canadian trends in opioid-related mortality and disability from opioid use disorder from 1990 to 2014 through the lens of the Global Burden of Disease Study

Orpana

Lang

Baxi

et al. 2018

Health Promot Chronic Dis Prev Can

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Introduction Several regions in Canada have recently experienced sharp increases in opioid overdoses and related hospitalizations and deaths. This paper describes opioid-related mortality and disability from opioid use disorder in Canada from 1990 to 2014 using data from the Global Burden of Disease (GBD) study. Methods We used data from the GBD study to describe temporal trends (1990–2014) in opioid-related mortality and disability from opioid use disorder using common metrics: disability-adjusted life years (DALY), deaths, years of life lost (YLL) and years lived with disability (YLD). We also compared age-standardized YLL and DALY rates per 100 000 population between Canada, the USA and other regions. Results The age-standardized opioid-related DALY rate in Canada was 355.5 per 100 000 population in 2014, which was higher than the global rate of 193.2, but lower than the rate of 767.9 in the United States. Between 1990 and 2014, the age-standardized opioid-related YLL rate in Canada increased by 142.2%, while globally this rate decreased by 10.1%. In comparison with YLL, YLD accounted for a larger proportion of the overall opioid-related burden across all age groups. Health loss was greater for males than females, and highest among those aged 25 to 29 years. Conclusion The health burden associated with opioid-related mortality and disability from opioid use disorder in Canada is significant and has increased dramatically from 1990 to 2014. These data point to a need for public health action including enhanced monitoring of a range of opioid-related harms.

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Section: Strengths and Limitationsmentioning

confidence: 60%

Canadian trends in opioid-related mortality and disability from opioid use disorder from 1990 to 2014 through the lens of the Global Burden of Disease Study

Orpana

Lang

Baxi

et al. 2018

Health Promot Chronic Dis Prev Can

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“…Indeed, many clinical guidelines advise against prescribing benzodiazepines in most seniors, let alone in combination with an opioid 28 29. Furthermore, patients aged 65 and older consistently have the highest rates of hospitalisation due to opioid poisoning 4…”

Section: Discussionmentioning

confidence: 99%

“…Canada has among the highest rates of opioid prescribing in the world and since 1980, the volume of opioids sold to hospitals and pharmacies has increased by 3000% despite increasing recognition of the significant prescribing risks associated with such practices, including fatal overdoses, dependency, motor vehicle collisions and falls and fractures among the elderly 1–3. Individuals older than 65 are especially prone to the consequences of opioids, with this group accounting for 63% of unintentional opioid poisonings and having the highest rate of opioid poisoning hospitalisations 3 4. A similar picture exists for benzodiazepines and Z-drugs (zopiclone and zolpidem), collectively known as benzodiazepine receptor modulators because of their effects on γ-aminobutyric acid receptors 5 6.…”

Section: Introductionmentioning

confidence: 97%

Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study

Sharma

Weir

Samanani³

et al. 2019

BMJ Open

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ObjectiveThe objective of this study is to characterise concurrent use of benzodiazepine receptor modulators and opioids among prescription opioid users in Alberta in 2017.DesignA population based retrospective study.SettingAlberta, Canada, in the year 2017.ParticipantsAll individuals in Alberta, Canada, with at least one dispensation record from a community pharmacy for an opioid in the year 2017.ExposureConcurrent use of a benzodiazepine receptor modulator and opioid, defined as overlap of supply for both drugs for at least 1 day.Main outcome measuresPrevalence of concurrency was estimated among subgroups of patient characteristics that were considered clinically relevant or associated with inappropriate medication use.ResultsAmong the 547 709 Albertans who were dispensed opioid prescriptions in 2017, 132 156 (24%) also received prescriptions for benzodiazepine receptor modulators. There were 96 581 (17.6%) prescription opioid users who concurrently used benzodiazepine receptor modulators with an average of 98 days (SD=114, 95% CI 97 to 99) of total cumulative concurrency and a median of 37 days (IQR 10 to 171). The average longest duration of consecutive days of concurrency was 45 (SD=60, 95% CI 44.6 to 45.4) with a median of 24 days (IQR 8 to 59). Concurrency was more prevalent in females, patients using an average daily oral morphine equivalent >90 mg, opioid dependence therapy patients, chronic opioid users, patients utilising a high number of unique providers, lower median household incomes and those older than 65 (p value<0.001 for all comparisons).ConclusionsConcurrent prescribing of opioids and benzodiazepine receptor modulators is common in Alberta despite the ongoing guidance of many clinical resources. Older patients, those taking higher doses of opioids, and for longer durations may be at particular risk of adverse outcomes and may be worthy of closer follow-up for assessment for dose tapering or discontinuations. As well, those with higher healthcare utilisation (seeking multiple providers) should also be closely monitored. Continued surveillance of concurrent use of these medications is warranted to ensure that safe drug use recommendations are being followed by health providers.

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“…9 In Canada, opioid overdosing increased in the past 10 years, reaching 15.6 per 100 000 in 2016-2017. 10 The differences between Europe and the USA are especially pronounced when comparing opioid-related deaths; although in Europe, deaths were stable at approximately 1.2 per 100 000 inhabitants per year in 2007 and 2016, there were 15 deaths per 100 000 inhabitants from opioid overdose in the USA in 2017. 8 Strengths and limitations of this study ► The large data set provides high power.…”

Section: Introductionmentioning

confidence: 99%

Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis

et al. 2020

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ObjectivesWe aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED).DesignRetrospective chart review.SettingLarge, interdisciplinary ED of a public hospital.ParticipantsAll patients aged ≥18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included.InterventionsNone.Primary and secondary outcome measuresPrevalence rates for prescription opioid use and its indication. Prevalence of analgesic comedications in prescription opioid users. Hospitalisation rate, 72 hours ED reconsultation rate, 30-day rehospitalisation rate, in-hospital mortality.ResultsA total of 26 224 consultations were included in the analysis; 1906 (7.3%) patients had prescriptions for opioids on admission to the ED. The main indications for opioid prescriptions were musculoskeletal disease in 1145 (60.1%) patients, followed by neoplastic disease in 374 (19.6%) patients. One hundred fifty-four (8.2%) consultations were directly related to opioid intake, and 50.1% of patients on opioids also used other classes of analgesics. Patients on prescription opioids were older (76 vs 62 years, p<0.0001) and female individuals were over-represented (58 vs 48.9%, p<0.0001). Hospitalisation rate (78.3 vs 49%, p<0.0001), 72 hours ED reconsultation rate (0.8 vs 0.3%, p=0.004), 30-day rehospitalisation rate (6.2 vs 1.5%, p<0.0001) and in-hospital mortality (6.3 vs 1.6%, p<0.0001) were significantly higher in patients with opioid therapy than other patients. In 25 cases (1.3%), admission to the ED was due to opioid intoxication.ConclusionsDaily prescription opioid use is common in patients presenting to the ED. The use of prescription opioids is associated with adverse outcomes, whereas intoxication is a minor issue in the studied population.

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At-a-glance - Hospitalizations and emergency department visits due to opioid poisoning in Canada

Cited by 34 publications

References 5 publications

Canadian trends in opioid-related mortality and disability from opioid use disorder from 1990 to 2014 through the lens of the Global Burden of Disease Study

Canadian trends in opioid-related mortality and disability from opioid use disorder from 1990 to 2014 through the lens of the Global Burden of Disease Study

Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study

Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis

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