Research Profile – Not What the Doctor Ordered

Prescription opioid abuse is on the rise, and various approaches are needed to stem the problem.

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Problems related to the non-medical use of prescription opioids (POs) are more extensive across the country than commonly thought.

Canada lacks consistent, quality data on the non-medical use of POs and PO-related harms. Yet, this sort of information is needed for developing interventions that can effectively prevent and treat abuse problems at the individual and population levels, according to Dr. Benedikt Fischer, professor of health sciences at Simon Fraser University.

The data available now “are highly fragmented, and not as systematic and comprehensive as they are in the U.S.,” says Dr. Fischer. To address this gap, he and his colleagues have been studying the issue for the past few years, and they uncovered several trends that could have far-reaching implications.

The challenge is to find ways to reduce abuse while still having these medications available for people who legitimately need them for pain relief, according to Dr. Fischer. After the U.S., Canada has the second highest rate of prescription-based opioids use in the world. Between 2000 and 2010, the amount of POs consumed in Canada increased by a whopping 200% – especially stronger (and riskier) opioid medications.

A study of dispensing rates and patterns for POs across the provinces from 2005 to 2010 found that Ontario and Alberta were dispensing 2.5 times as many opioids as Quebec. Also, stronger POs such as oxycodone and hydrocodone are consumed at high levels in some provinces but not in others.

A key finding of Dr. Fischer’s work is that, at the population level, the amount of POs dispensed is closely associated with parallel increases in PO-related deaths and complications needing treatment.

Unfortunately, increased PO prescribing is generally accompanied by a smaller, parallel increase in the number of people who use the drugs to get high. Estimates place non-medical use of POs as the fourth most prevalent form of substance abuse after alcohol, tobacco and cannabis. Between 500,000 and 1.25 million people are estimated to use POs non-medically in Canada.

“Of these, between 125,000 to 200,000 users may be dependent, and likely need treatment,” says Dr. Fischer.

U.S. studies show that about two in five acute drug poison deaths are associated with POs – causing more deaths than those from heroin or cocaine combined, or from motor vehicle accidents. The situation appears similar in Canada.

“The increased use of prescription opioids contributes to a substantial mortality and morbidity burden in North America, and evidence-based interventions to reduce this burden are urgently needed,” says Dr. Fischer.

Dr. Fischer’s team performed an analysis of the key characteristics of PO misusers. They found that people who were suffering from mental health problems (especially depression) or pain issues were two to three times more likely to report non-medical use of POs than people without these problems. This is an important finding, because people with mental health and pain issues may need different types of interventions than other groups.

A study of 4,023 adults and 3,266 students (grades 7 to 12) in the general Ontario population found non-medical PO use was more common among students than adults – 15.5% and 5.9%, respectively. Notably, the study showed that non-medical PO use was widespread across most socio-demographic groups. There were also some associations with other forms of substance abuse, implying the need for both broad and targeted measures to better prevent non-medical PO use, according to Dr. Fischer.

Recently, most provinces delisted select oxycodone products from their drug formularies to stem harms related to these drugs, yet problems may have partly shifted to other POs. Research is ongoing to better understand the key drivers behind PO-related problems and what interventions can alleviate these without undue ‘side effects’.

“The increased use of prescription opioids contributes to a substantial mortality and morbidity burden in North America, and evidence-based interventions to reduce this burden are urgently needed.”
– Dr. Benedikt Fischer, Simon Fraser University