Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Cairncross, Zoe F; Herring, Jeremy; Ingen, Trevor van; Smith, Brendan T.; Leece, Pamela; Schwartz, Brian; Hohenadel, Karin

doi:10.9778/cmajo.20180084

Cited by 15 publications

(12 citation statements)

References 33 publications

(38 reference statements)

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“…The opioid epidemic has disproportionately affected low-income communities in Canada. 16 In bivariate analysis, highest income quintile was associated with lower dose outcome as compared with the lowest income quintile. This finding is consistent with an American study showing that increasing income is associated with smaller doses of opioids in comparison with the lowest income brackets.…”

Section: Discussionmentioning

confidence: 95%

Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study

Kirubalingam

Nguyen

Klar³

et al. 2021

Otolaryngol.--head neck surg.

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Objective To examine postoperative opioid-prescribing patterns following otologic surgery. Study Design Retrospective population-based descriptive study. Setting All hospitals in the Canadian province of Ontario. Methods Of all patients with advanced ear surgery between July 1, 2012, and March 31, 2019, 7 cohorts were constructed: tympanoplasty with or without ossiculoplasty (n = 7812), atticotomy/limited mastoidectomy (n = 1371), mastoidectomy (n = 3717), semicircular canal occlusion (SCO; n = 179), stapedectomy (n = 2735), bone-implanted hearing aid insertion (n = 280), and cochlear implant (n = 2169). Prescriptions filled for narcotics postoperatively were calculated per morphine milligram equivalent (MME) opioid dose. Multivariable regression was used to determine predictors of higher opioid doses. Results The mean ± SD MMEs prescribed were as follows: tympanoplasty with or without ossiculoplasty, 246.77 ± 1380.78; atticotomy/limited mastoidectomy, 283.32 ± 956.10; mastoidectomy, 280.56 ± 1018.50; SCO, 328.61 ± 1090.86; stapedectomy, 164.64 ± 657.18; bone-implanted hearing aid insertion, 326.11 ± 1054.66; and cochlear implant, 200.87 ± 639.93. SCO (odds ratio [OR], 1.69 [95% CI, 1.16-2.48]) and mastoidectomy (OR, 1.50 [95% CI, 1.36-1.66]) were associated with higher opioid doses than tympanoplasty-ossiculoplasty. Asthma (OR, 1.24 [95% CI, 1.12-1.38]), chronic obstructive pulmonary disease (OR, 1.29 [95% CI, 1.12-1.47]), myocardial infarction (OR, 1.33 [95% CI, 1.05-1.68]), diabetes (OR, 1.22 [95% CI, 1.08-1.39]), and substance-related and addictive disorders (OR, 2.59 [95% CI, 1.67-4.00]) were associated with higher opioid doses prescribed. Overall MME prescribed by year demonstrates a sharp drop from 2017-2018 to 2018-2019. Conclusion This large comprehensive population study provides insight into the prescribing patterns following otologic surgery. The large amounts prescribed and substantial variation require further study to determine barriers that limit good opioid-prescribing stewardship in the postoperative period.

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Section: Discussionmentioning

confidence: 95%

Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study

Kirubalingam

Nguyen

Klar³

et al. 2021

Otolaryngol.--head neck surg.

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“…We used comprehensive administrative databases as they provide a broad picture of opioid mortality, hospitalization and ED visits in Canada [13][14][15][16][17].…”

Section: Data Sourcesmentioning

confidence: 99%

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

et al. 2021

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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.

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“…While all socioeconomic groups are being affected by the opioid crisis, disparities can be seen in different populations. For example, individuals living in low-income communities in Ontario, Canada, have experienced harm at a substantially higher rate than those who lived in high-income communities [ 6 ]. Similar findings are seen in the United States [ 7 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review

Martignetti¹,

Sun²

2022

Cureus

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The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.

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Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Cited by 15 publications

References 33 publications

Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study

Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study

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

Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review

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