National trends in population rates of opioid‐related mortality, hospitalization and emergency department visits in Canada between 2000 and 2017. A population‐based study

Abstract

Background and aimsExisting assessments of the time-trends of opioid-related mortality, hospitalization and emergency department visits in Canada have relied mainly on provincial databases, while national assessments generally do not provide information before 2016. We aimed to estimate Canadian national time trends in opioid-related mortality from 2000 to 2017 and opioid-related hospitalization and emergency department visits between 2000 and 2012.Design Retrospective cohort study. Setting and participants Residents of all Canadian provinces and territories for which comparable data were available from 2000 to 2017. Measurements We identified opioid-related mortality, hospitalization and emergency department visits using validated algorithms using ICD codes from administrative databases. We calculated crude rates and sex-and age-adjusted rates per million. For hospitalizations, we calculated case-fatality, 90-day and 365-day all-cause mortality and opioid-related re-hospitalization rates. We used Poisson regression to examine the significance of the time trend. Findings From 2000 to 2017, the adjusted opioid mortality rate in Canada (outside Quebec) increased significantly by 592.9% (from 20.0 opioid deaths per million in 2000 to 118.3 in 2017). The highest year-to-year increases were from 2015 to 2016 (31.8%) and from 2016 to 2017 (52.2%). The adjusted hospitalizations doubled significantly during the study period (an increase of 103.7%, from 159.7 opioid hospitalizations per million Canadians in 2000 to 325.3 in 2012). The adjusted rate of emergency department visits increased significantly by 188.7% (from 280.6 per million in 2000 to 810.1 in 2012). Case-fatality was 2.3% overall and was mainly constant during the study period. Both 90-and 365-day all-cause mortality increased significantly between 2000 and 2011 (from 1.7 to 3.1% and 3.9 to 7.4%, respectively), while re-hospitalization for opioid-related diagnoses was reduced (from 7.8 to 6.4% and 14.2 to 12.9%, respectively). Conclusions Opioid-related mortality, hospitalization and emergency department visits in Canada have been increasing gradually since 2000.

Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis

“…We previously published a similar network meta-analysis that assessed the effectiveness of oral NSAIDs and paracetamol 33. With the ever increasing use of opioids in osteoarthritis treatment and the recommendation from recent guidelines to consider topical NSAIDs as a first line treatment, we expanded the previous review to also include these interventions to assess their comparative effectiveness and safety 67891618. We also included safety outcomes in the current review, which were not reported in our previous review.…”

“…17 Between 2000 and 2017, opioid related mortality increased by 593% in Canada. 18 Despite this evidence, and international concerns about the devastating potential for chemical dependency, 7 19 opioids remain among the most prescribed drugs for osteoarthritis pain in the UK, the US, Canada, and Australia, even though safer treatments with stronger analgesic effects are available. 9 20-23 Previous systematic reviews have reported the effectiveness of NSAIDs and opioids to treat osteoarthritis pain.…”

“…Over half of all global overdose deaths in 2019 occurred in the US, with liberal prescribing of high dose opioids one of the main contributors 17. Between 2000 and 2017, opioid related mortality increased by 593% in Canada 18. Despite this evidence, and international concerns about the devastating potential for chemical dependency,719 opioids remain among the most prescribed drugs for osteoarthritis pain in the UK, the US, Canada, and Australia, even though safer treatments with stronger analgesic effects are available 920212223…”

Association of obstructive sleep apnea and opioids use on adverse health outcomes: A population study of health administrative data

“…While prescribed opioid use has been shown to be associated with increased mortality, hospitalizations, and ED visits [ 3 , 4 ], the effect on cardiovascular outcomes remains controversial [ 11 ]. In our study, we demonstrated an increased hazard of IHD-hospitalizations associated with prescribed opioids regardless of OSA status.…”

“…The ongoing opioid epidemic in North America [ 1 ] has led to an increased frequency of adverse opioid-related outcomes, such as higher rates of emergency department (ED) visits, hospitalization, and mortality [ 2 , 3 ]. Although the current epidemic and adverse outcomes are no longer being driven by prescribed opioids for therapeutic use [ 4 , 5 ], safe prescribing of opioids is still important [ 6 ].…”