Reductions in non-medical prescription opioid use among adults in Ontario, Canada: are recent policy interventions working?

Substance Abuse Treatment, Prevention, and Policy

Jürgen Rehm²  Robert E Mann³  Paul Kurdyak⁴  Anca Ialomiteanu¹  Benedikt Fischer⁴ 

[1] Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada;Technische Universitaet Dresden, Dresden, Germany;Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;Department of Psychiatry, University of Toronto, Toronto, Canada

关键词: Canada;    Population health;    Prescription monitoring;    Interventions;    Policy;    Non-medical use;    Prescription opioids;   

Others  :  834428
DOI  :  10.1186/1747-597X-8-7

 received in 2012-11-27, accepted in 2013-02-12,  发布年份 2013

【 摘 要 】

Background

Non-medical prescription opioid use (NMPOU) and prescription opioid (PO) related harms have become major substance use and public health problems in North America, the region with the world’s highest PO use levels. In Ontario, Canada’s most populous province, NMPOU rates, PO-related treatment admissions and accidental mortality have risen sharply in recent years. A series of recent policy interventions from governmental and non-governmental entities to stem PO-related problems have been implemented since 2010.

Findings

We compared the prevalence of NMPOU in the Ontario general adult population (18 years+) in 2010 and 2011 based on data from the ‘Centre for Addiction and Mental Health (CAMH) Monitor’ (CM), a long-standing annual telephone interview-based representative population survey of substance use and health indicators. While ‘any PO use’ (in past year) changed non-significantly from 26.6% to 23.9% (Chi2 = 2.511; df = 1; p =  0.113), NMPOU decreased significantly from 7.7% to 4.0% (Chi2 = 14.786; df = 1; p < 0.001) between 2010 and 2011. Over-time changes varied by age group but not by sex.

Conclusions

The observed substantial decrease in NMPOU in the Ontario adult population could be related to recent policy interventions, alongside extensive media reporting, focusing on NMPOU and PO-related harms, and may mean that these interventions have shown initial effects. However, other casual factors could have been involved. Thus, it is necessary to systematically examine whether the observed changes will be sustained, and whether other key PO-related harm indicators (e.g., treatment admissions, accidental mortality) change correspondingly in order to more systematically assess the impact of the policy measures.

【 授权许可】

   
2013 Fischer et al; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Fischer B, Argento E: Prescription opioid related misuse, harms, diversion and interventions in Canada: a review. Pain Physician 2012, 15(3 Suppl):ES191-ES203.
• [2]Dhalla IA, Mamdani MM, Sivilotti ML, Kopp A, Qureshi O, Juurlink DN: Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ 2009, 181(12):891-896.
• [3]Volkow ND, McLellan TA: Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. JAMA 2011, 305(13):1346-1347.
• [4]Manchikanti L, Fellows B, Ailinani H, Pampati V: Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician 2010, 13(5):401-435.
• [5]Fischer B, Jones W, Krahn M, Rehm J: Differences and over-time changes in levels of prescription opioid analgesic dispensing from retail pharmacies in Canada, 2005–2010. Pharmacoepidemiol Drug Saf 2011, 20(12):1269-1277.
• [6]Dasgupta N, Kramer ED, Zalman MA, Carino S, Smith MY, Haddox JD, Wright C: Association between non-medical and prescriptive usage of opioids. Drug Alcohol Depend 2006, 82(2):135-142.
• [7]Fischer B, Ialomiteanu A, Boak A, Adlaf E, Rehm J, Mann R: Prevalence and key co-variates of non-medical prescription opioid use among the general secondary student and adult populations in Ontario, Canada. Drug Alcohol Rev . in press
• [8]Brands B, Paglia-Boak A, Sproule BA, Leslie K, Adlaf EM: Nonmedical use of opioid analgesics among Ontario students. Can Fam Physician 2010, 56(3):256-262.
• [9]Fischer B, Nakamura N, Rush B, Rehm J, Urbanoski K: Changes in and characteristics of admissions to treatment related to problematic prescription opioid use in Ontario, 2004–2009. Drug Alcohol Depend 2010, 109(1–3):257-260.
• [10]Gomes T, Juurlink DN, Moineddin R, Gozdyra P, Dhalla I, Paterson M, Mamdani MM: Geographical variation in opioid prescribing and opioid-related mortality in Ontario. Healthc Q 2011, 14(1):22-24.
• [11]Kurdyak P, Gomes T, Yao Z, Mamdani MM, Hellings C, Fischer B, Rehm J, Bayoumi AM, Juurlink DN: Use of other opioids during methadone therapy: a population-based study. Addiction 2012, 107(4):776-780.
• [12]College of Physicians and Surgeons of Ontario: Avoiding Abuse, Achieving a Balance: Tackling the Opioid Public Health Crisis. Toronto, ON: College of Physicians and Surgeons of Ontario; 2010. http://www.cpso.on.ca/uploadedFiles/policies/positions/Opioid%20report%20final.pdf webcite
• [13]Ontario Ministry of Health and Long-term Care: The Narcotics Safety and Awareness Act, 2010. http://www.health.gov.on.ca/en/common/legislation/ons/default.aspx webcite
• [14]Brushwood DB: Brushwood DB. Maximizing the value of electornic prescription monitoring programs. J Law Med Ethics 2003, 31:41-54.
• [15]Gugelmann HM, Perrone J: Can prescription drug monitoring programs help limit opioid abuse? JAMA 2011, 306(20):2258-2259.
• [16]Fischer B, Keates A: ‘Opioid Drought’, Canadian-style? Potential implications of the ‘natural experiment’ of delisting Oxycontin in Canada. Int J Drug Policy 2012, 23(6):495-497.
• [17]Blackwell T: Canada’s deadly love affair with painkillers. National Post, Nov 14, 2011; http://news.nationalpost.com/2011/11/14/canadas-deadly-love-affair-with-painkillers/ webcite
• [18]CBC: The Fifth Estate: Time Bomb. http://www.cbc.ca/fifth/2011-2012/timebomb/ webcite
• [19]Picard A: The OxyContin switch: a lost battle in our War on Pain. The Globe and Mail, Mar 06, 2012:A.1. http://search.proquest.com/docview/926265065?accountid=13800 webcite
• [20]Ialomiteanu A, Adlaf EM, Hamilton H, Mann RE: CAMH Monitor eReport: Addiction and Mental Health Indicators among Ontario Adults 1977–2011. Toronto, ON: Centre for Addiction and Mental Health; 2012. [CAMH Research Document Series No. 35] http://www.camh.ca/en/research/news_and_publications/CAMH%20Monitor/CM2011_eReport_Final.pdf webcite
• [21]Substance Abuse and Mental Health Services Administration (SAMHSA): Results from the 2011 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012. http://www.samhsa.gov/data/NSDUH/2011SummNatFindDetTables/NSDUH-DetTabsPDFWHTML2011/2k11DetailedTabs/Web/HTML/NSDUH-DetTabsTOC2011.htm webcite
• [22]Gilson AM, Kreis PG: The burden of the nonmedical use of prescription opioid analgesics. Pain Med 2009, 10(Suppl 2):S89-S100.
• [23]Passik SD, Kirsh K: The interface between pain and drug abuse and the evolution of strategies to optimize pain management while minimizing drug abuse. Exp Clin Psychopharmacol 2008, 16(5):400-404.
• [24]Franklin GM, Mai J, Turner J, Sullivan M, Wickizer T, Fulton-Kehoe D: Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. Am J Ind Med 2012, 55(4):325-331.
• [25]Ratnasingham S, Cairney J, Rehm J, Manson H, Kurdyak P: Opening Eyes, Opening Minds: The Ontario Burden of Mental Illness and Addictions Report. Toronto, ON: Institute for Clinical Evaluative Sciences and Public Health Ontario; 2012. http://www.oahpp.ca/resources/documents/reports/opening-eyes-mental-health/PHO-ICES%20Opening%20Eyes%20Opening%20Minds%20Report%20-%20Oct%202012%20final.pdf webcite