Abstract: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, 2… Show more
“…This involves only about 0.5–1.5 % prevalence and is thus substantially lower than levels reported for North America [ 13 , 87 ]. These observations appear to confirm that overall population-level opioid availability determines corresponding levels of opioid-related harms (e.g., non-medical use or mortality) [ 69 , 71 , 88 ]. Available indicators are limited in regard to contexts of non-medical use.…”
Section: Discussionmentioning
confidence: 55%
“…It is rather unclear what the Brazilian context of opioid utilization means for the needs, practices, and outcomes related to pain care given that many countries find themselves in a major recalibration phase (e.g., with major changes in opioid utilization control and practice) as to the role of opioid-pharmacotherapy in evidence-based approaches for pain care while minimizing collateral harms [ 5 , 22 , 69 , 70 ]. While North America and other wealthy nations have vastly increased utilization of (especially strong) opioids in a quest for ‘better’ pain care post-1990, many subsequently experience unprecedented adverse consequences from opioid-related fatalities, hospitalizations, and dependence, driven by persistent increases in opioid availability [ 11 , 71 , 72 ]. Increasing adverse consequences following recent restrictions on prescription opioids have been related to illicit/synthetic opioid products that appear to fill ‘supply gaps’ [ 9 , 73 – 75 ].…”
Background
Global opioid consumption increased multifold post-2000, disproportionately in high-income countries, with severe mortality/morbidity consequences. Latin America features comparatively low opioid availability; Brazil, the region’s most populous country, makes an interesting case study concerning opioid use/harms. In this comprehensive overview, we aimed to identify and summarize medical and non-medical data and indicators of opioid availability and use, regulation/control, and harm outcomes in Brazil since 2000.
Methods
We searched multiple scientific databases to identify relevant publications and conducted additional ‘grey’ literature searches to identify other pertinent information.
Results
Despite some essential indicators, opioid-related data are limited for Brazil. Data indicate that population-level availability of prescription opioids represents only a small fraction of use in comparison to high-income countries. However, within Latin America, Brazil ranks mid-level for opioid consumption, indicating relatively moderate consumption compared to neighboring jurisdictions. Brazil has implemented restrictive regulations to opioid prescribing and is considered ‘highly restricted’ for opioid access. Codeine remains the major opioid analgesic utilized, but stronger opioids such as oxycodone are becoming more common. Professional knowledge regarding medical opioid use and effects appears limited. National surveys indicate increases in non-medical use of prescription opioids, albeit lower than observed in North America, while illicit opioids (e.g., heroin) are highly uncommon.
Conclusions
Overall population-level opioid availability and corresponding levels of opioid-related harms in Brazil remain substantially lower than rates reported for North America. However, the available surveillance and analytical data on opioid use, policy/practice, and harms in Brazil are limited and insufficient. Since existing and acute (e.g., pain-related) needs for improved opioid utilization and practice appear to be substantiated, improved indicators for and understanding of opioid use, practice, and harms in Brazil are required.
“…This involves only about 0.5–1.5 % prevalence and is thus substantially lower than levels reported for North America [ 13 , 87 ]. These observations appear to confirm that overall population-level opioid availability determines corresponding levels of opioid-related harms (e.g., non-medical use or mortality) [ 69 , 71 , 88 ]. Available indicators are limited in regard to contexts of non-medical use.…”
Section: Discussionmentioning
confidence: 55%
“…It is rather unclear what the Brazilian context of opioid utilization means for the needs, practices, and outcomes related to pain care given that many countries find themselves in a major recalibration phase (e.g., with major changes in opioid utilization control and practice) as to the role of opioid-pharmacotherapy in evidence-based approaches for pain care while minimizing collateral harms [ 5 , 22 , 69 , 70 ]. While North America and other wealthy nations have vastly increased utilization of (especially strong) opioids in a quest for ‘better’ pain care post-1990, many subsequently experience unprecedented adverse consequences from opioid-related fatalities, hospitalizations, and dependence, driven by persistent increases in opioid availability [ 11 , 71 , 72 ]. Increasing adverse consequences following recent restrictions on prescription opioids have been related to illicit/synthetic opioid products that appear to fill ‘supply gaps’ [ 9 , 73 – 75 ].…”
Background
Global opioid consumption increased multifold post-2000, disproportionately in high-income countries, with severe mortality/morbidity consequences. Latin America features comparatively low opioid availability; Brazil, the region’s most populous country, makes an interesting case study concerning opioid use/harms. In this comprehensive overview, we aimed to identify and summarize medical and non-medical data and indicators of opioid availability and use, regulation/control, and harm outcomes in Brazil since 2000.
Methods
We searched multiple scientific databases to identify relevant publications and conducted additional ‘grey’ literature searches to identify other pertinent information.
Results
Despite some essential indicators, opioid-related data are limited for Brazil. Data indicate that population-level availability of prescription opioids represents only a small fraction of use in comparison to high-income countries. However, within Latin America, Brazil ranks mid-level for opioid consumption, indicating relatively moderate consumption compared to neighboring jurisdictions. Brazil has implemented restrictive regulations to opioid prescribing and is considered ‘highly restricted’ for opioid access. Codeine remains the major opioid analgesic utilized, but stronger opioids such as oxycodone are becoming more common. Professional knowledge regarding medical opioid use and effects appears limited. National surveys indicate increases in non-medical use of prescription opioids, albeit lower than observed in North America, while illicit opioids (e.g., heroin) are highly uncommon.
Conclusions
Overall population-level opioid availability and corresponding levels of opioid-related harms in Brazil remain substantially lower than rates reported for North America. However, the available surveillance and analytical data on opioid use, policy/practice, and harms in Brazil are limited and insufficient. Since existing and acute (e.g., pain-related) needs for improved opioid utilization and practice appear to be substantiated, improved indicators for and understanding of opioid use, practice, and harms in Brazil are required.
“…-Naandwe Miikan OAT Client Since Health Canada approved the opioid pain medication OxyContin in 2000, communities in Canada have been affected by rapidly increasing trends in problematic prescription and illicit opioid use leading to growing opioid-related poisoning, first responder calls, emergency department visits, and deaths (Belzak & Halverson, 2018;Jones et al, 2020). All of Canada is affected by the opioid crisis, but there are regional inequities, including access to treatment services and rates of overdose deaths (Belzak & Halverson, 2018).…”
Section: Community-led Recovery From the Opioid Crisis Through Cultur...mentioning
The opioid crisis is disproportionately impacting Indigenous communities in Canada. There is a need to evaluate practical approaches to recovery that include community-based opioid agonist treatment (OAT) and integration of cultural treatment models. Naandwe Miikan, translated as The Healing Path, is an OAT program that blends clinical and Indigenous healing concepts and providers in a community-based setting. Aside from OAT pharmaceutical treatment, clients work with Indigenous counsellors that integrate culture with treatment, such as land-based activities, that reconnect the community to Indigenous teachings and harvesting. In this paper, we present a case study showcasing community advocacy in creating innovative funding models and engaging with clinicians to provide a shared care OAT model with traditional Indigenous counselling, cultural programs, and data sovereignty. Policy needs are identified.
“…Double binds arising from confused messaging around care vs. cure can, in turn, create a pragmatic bias in what kind of treatment approach is acceptable ( 117 ). An instance of this conflicted messaging is that while the long-term efficacy of many pharmacological treatments for chronic pain remains uncertain ( 118 – 120 ), complementary, and alternative medicine (CAM) approaches are often dismissed outright by biomedicine as “quack science” ( 121 ). Even in a country like Germany—with its 200-year legacy of alternative medicine ( 122 )—only half of physicians surveyed had a positive attitude toward CAMs ( 123 ).…”
Section: Theory: a Cybernetic Approach To Studying Pain By Playingmentioning
The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.
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