Kate Smolina1, Alexis Crabtree2, Mei Chong3, Bin Zhao3, Mina Park3, Christopher Mill4, Christian G Schütz5. 1. BC Centre for Disease Control, 655 W 12thAvenue, Vancouver, BC, V5Z 4R42 Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. Electronic address: kate.smolina@bccdc.ca. 2. BC Centre for Disease Control, 655 W 12thAvenue, Vancouver, BC, V5Z 4R42 Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. 3. BC Centre for Disease Control, 655 W 12thAvenue, Vancouver, BC, V5Z 4R42 Canada. 4. Public Health Agency of Canada, Government of Canada, 130 Colonnade Road, Ottawa, ON, K1A 0K9, Canada. 5. Institute of Mental Health, Department of Psychiatry, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada; The Burnaby Centre for Mental Health & Addiction, 3405 Willingdon Avenue, Burnaby, BC, V5G 3H4, Canada.
Abstract
BACKGROUND: British Columbia is the epicenter of the current fentanyl-related overdose crisis in Canada. Our study characterizes prescribing histories of people who had an opioid-related overdose compared to matched controls. METHODS: We examined linked administrative data for individuals who overdosed between January 1, 2015 and November 30, 2016. Past prescriptions over five years were assessed for opioids for pain, opioid agonist therapy, benzodiazepines/z-drugs, antidepressants, antipsychotics, gabapentinoids, mood stabilizers and anti-epileptics, muscle relaxants, and other sedating medications. Prescribing history of 9964 cases was compared with that of 49,820 matched controls. RESULTS: Overdose cases were more likely to be prescribed opioids for pain and to have used prescription opioids on a long-term basis in the previous five years compared to controls. However, at the time of overdose, 92% of men and 86% of women did not have an active opioid for pain prescription, and approximately half had not filled one in the past five years. Those who overdosed tended to have more prescriptions for psychotropic substances than controls. Fewer than 10% of cases had an active prescription for opioid agonist therapy and most were not on treatment in the past. CONCLUSIONS: Low prevalence of active prescriptions for opioids for pain at the time of overdose suggests that opioid prescribing plays a limited short-term impact in the current fentanyl-related crisis of overdoses. While liberal opioid prescribing practices may have contributed to the development of the current overdose crisis, regulation and enforcement of clinicians' prescribing practices will likely have limited impact in reducing overdoses.
BACKGROUND:British Columbia is the epicenter of the current fentanyl-related overdose crisis in Canada. Our study characterizes prescribing histories of people who had an opioid-related overdose compared to matched controls. METHODS: We examined linked administrative data for individuals who overdosed between January 1, 2015 and November 30, 2016. Past prescriptions over five years were assessed for opioids for pain, opioid agonist therapy, benzodiazepines/z-drugs, antidepressants, antipsychotics, gabapentinoids, mood stabilizers and anti-epileptics, muscle relaxants, and other sedating medications. Prescribing history of 9964 cases was compared with that of 49,820 matched controls. RESULTS:Overdose cases were more likely to be prescribed opioids for pain and to have used prescription opioids on a long-term basis in the previous five years compared to controls. However, at the time of overdose, 92% of men and 86% of women did not have an active opioid for pain prescription, and approximately half had not filled one in the past five years. Those who overdosed tended to have more prescriptions for psychotropic substances than controls. Fewer than 10% of cases had an active prescription for opioid agonist therapy and most were not on treatment in the past. CONCLUSIONS: Low prevalence of active prescriptions for opioids for pain at the time of overdose suggests that opioid prescribing plays a limited short-term impact in the current fentanyl-related crisis of overdoses. While liberal opioid prescribing practices may have contributed to the development of the current overdose crisis, regulation and enforcement of clinicians' prescribing practices will likely have limited impact in reducing overdoses.
Authors: Alexandra B Collins; Jade Boyd; Samara Mayer; Al Fowler; Mary Clare Kennedy; Ricky N Bluthenthal; Thomas Kerr; Ryan McNeil Journal: Int J Drug Policy Date: 2019-09-18
Authors: Eric P Borrelli; Blake Morphis; Rouba Youssef; Laura C Chambers; Benjamin D Hallowell; Jeffrey Bratberg; Stephen J Kogut Journal: R I Med J (2013) Date: 2020-10-01
Authors: Kanna Hayashi; Evan Wood; Huiru Dong; Jane A Buxton; Nadia Fairbairn; Kora DeBeck; M-J Milloy; Thomas Kerr Journal: Drug Alcohol Rev Date: 2021-02-18
Authors: James Wilton; Stanley Wong; Roy Purssell; Younathan Abdia; Mei Chong; Mohammad Ehsanul Karim; Aaron MacInnes; Sofia R Bartlett; Rob F Balshaw; Tara Gomes; Amanda Yu; Maria Alvarez; Richard C Dart; Mel Krajden; Jane A Buxton; Naveed Z Janjua Journal: JAMA Netw Open Date: 2022-01-04
Authors: James Wilton; Younathan Abdia; Mei Chong; Mohammad Ehsanul Karim; Stanley Wong; Aaron MacInnes; Rob Balshaw; Bin Zhao; Tara Gomes; Amanda Yu; Maria Alvarez; Richard C Dart; Mel Krajden; Jane A Buxton; Naveed Z Janjua; Roy Purssell Journal: BMJ Date: 2021-11-18