OpenLB
Open Library of Bioscience
Advanced Search
Pain and therapy
Jun, 2021;10 (1): 15-23.

Comparison of Crude Population-Level Indicators of Opioid Use and Related Harm in New Zealand and Ontario (Canada).

Benedikt Fischer, Dimitri Daldegan-Bueno, Wayne Jones
Author Information
  1. Benedikt Fischer: Faculty of Medical and Health Sciences, Schools of Population Health and Pharmacy, University of Auckland, Auckland, New Zealand. b.fischer@auckland.ac.nz. ORCID
  2. Dimitri Daldegan-Bueno: Faculty of Medical and Health Sciences, Schools of Population Health and Pharmacy, University of Auckland, Auckland, New Zealand.
  3. Wayne Jones: Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.
PMID: 33382438 DOI: 10.1007/s40122-020-00229-6

Abstract

North America and select other Commonwealth jurisdictions have been experiencing unprecedented opioid epidemics characterized by excessive and persistently high levels of opioid misuse, morbidity and mortality, and related disease burden. Recent discussions have considered whether New Zealand might undergo or needs to expect a similar 'opioid crisis'. Towards further informing these considerations, we examine and compare essential, publicly available indicators of opioid utilization and harms (mortality) from New Zealand and the Canadian province of Ontario, due to the fact that both operate public health care systems in similar socio-cultural settings. We find that the two jurisdictions have featured vastly different population levels of opioid exposure, opioid consumption patterns (e.g., high-dose/long-term/high-risk prescribing) known as key predictors of adverse outcomes, and levels of opioid mortality as evidenced by concrete epidemiological indicators and data. Specifically for opioid-related death rates, these were already approximately threefold higher in Ontario compared to New Zealand based on most recent comparison data (e.g., 2012); these differentials have likely further grown more recently given major and distinct changes in population-level opioid exposure and risks, and subsequent opioid-related deaths since then in Ontario. Based on the present data and related evidence, New Zealand does not seem to need to anticipate an opioid mortality epidemic similar to that experienced in North America; however, it would be of interest to establish more comprehensive and timely surveillance of key system-level indicators of opioid use and harms as are standard in North America. As such, this inter-jurisdictional comparison makes for a case study in starkly contrasting scenarios of opioid use and harms, the drivers behind which deserve further systematic examination.

Keywords

Canada Epidemiology Mortality New Zealand Opioids Policy

References

  1. Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The burden of opioid-related mortality in the United States. JAMA Network Open. 2018;1(2):e180217-e. [PMID: 30646062]
  2. Saloner B, McGinty EE, Beletsky L, Bluthenthal R, Beyrer C, Botticelli M, et al. (2018) A public health strategy for the opioid crisis. Public Health Rep. 133(1_suppl):24S-34S.
  3. Fischer B, Pang M, Tyndall M. The opioid death crisis in Canada: crucial lessons for public health. Lancet Public Health. 2019;4(2):e81–2. [PMID: 30579840]
  4. Vojtila L, Pang M, Goldman B, Kurdyak P, Fischer B. Non-medical opioid use, harms, and interventions in Canada—a 10-year update on an unprecedented substance use-related public health crisis. Drugs Educ Prev Policy. 2020;27(2):118–22.
  5. Wilson N, Kariisa M, Seth P, Smith HI, Davis N. Drug and opioid-involved overdose deaths—United States, 2017–2018. Morb Mortal Wkly Rep. 2020;69:290–7.
  6. Orpana HM, Lang JJ, George D, Halverson J. At-a-glance—the impact of poisoning-related mortality on life expectancy at birth in Canada, 2000 to 2016. Public Health Agency Can. 2019;39(2):56–60.
  7. Woolf SH, Schoomaker H. Life expectancy and mortality rates in the United States, 1959–2017. JAMA. 2019;322(20):1996–2016. [PMID: 31769830]
  8. Ye X, Sutherland J, Henry B, Tyndall M, Kendall PRW. At-a-glance—impact of drug overdose-related deaths on life expectancy at birth in British Columbia. Health Promot Chronic Dis Prev Can Res Policy Pract. 2018;38(6):248–51.
  9. Dowell D, Arias E, Kochanek K, Anderson R, Guy GP Jr, Losby JL, et al. Contribution of opioid-involved poisoning to the change in life expectancy in the United States, 2000–2015. JAMA. 2017;318(11):1065–7. [PMID: 28975295]
  10. Larance B, Degenhardt L, Peacock A, Gisev N, Mattick R, Colledge S, et al. Pharmaceutical opioid use and harm in Australia: the need for proactive and preventative responses. Drug Alcohol Rev. 2018;37(S1):S203–5. [PMID: 29024092]
  11. EMCDDA. Drug-related deaths and mortality in Europe: Update from the EMCDDA expert network. Luxembourg: Publications Office of the European Union; 2019.
  12. Morrow PL. The American opioid death epidemic—lessons for New Zealand? N Z Med J. 2018;131(1469):59–63. [PMID: 29389930]
  13. Shipton EA. The opioid epidemic—a fast developing public health crisis in the first world. N Z Med J. 2018;131(1469):7–9. [PMID: 29389923]
  14. Gomes T, Greaves S, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. Measuring the burden of opioid-related mortality in Ontario. Can J Addict Med. 2018;12(5):418–9. [PMID: 29697503]
  15. Braithwaite J, Hibbert P, Blakely B, Plumb J, Hannaford N, Long JC, et al. Health system frameworks and performance indicators in eight countries: a comparative international analysis. SAGE Open Med. 2017;5:2050312116686516. [PMID: 28228948]
  16. INCB. Narcotic drugs—technical report Austria: United Nations Publication; 2020. Available from: https://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/narcotic_drugs_reports.html . Accessed 30 Aug 2020
  17. INCB. Narcotic drugs: estimated world requirements for 2020—statistics for 2018. New York: United Nations Publication; 2020. p. 2019.
  18. INCB. Narcotic drugs: estimated world requirements for 2013—statistics for 2011. New York: United Nations Publication; 2013. p. 2013.
  19. INCB. Narcotic drugs: estimated world requirements for 2004—statistics for 2002. New York: United Nations Publication; 2004. p. 2003.
  20. Health Quality and Safety Commission. Atlas of healthcare variation: Opioids 2019. Available from: https://public.tableau.com/profile/hqi2803#!/vizhome/Opioidssinglemap/AtlasofHealthcareVariationOpioids . Accessed 30 Aug 2020
  21. Shipton EE, Shipton AJ, Williman JA, Shipton EA. Deaths from opioid overdosing: Implications of coroners’ inquest reports 2008–2012 and annual rise in opioid prescription rates: a population-based cohort study. Pain Ther. 2017;6(2):203–15. [PMID: 28887789]
  22. Fountain JS, Reith DM, Tomlin AM, Smith AJ, Tilyard MW. Deaths by poisoning in New Zealand, 2008–2013. Clin Toxicol. 2019;57(11):1087–94.
  23. Fischer B, Rehm J, Tyndall M. Effective Canadian policy to reduce harms from prescription opioids: learning from past failures. Can Med Assoc J. 2016;188(17–18):1240–4.
  24. Fischer B, Jones W, Vojtila L, Kurdyak P. Patterns, changes, and trends in prescription opioid dispensing in Canada, 2005–2016. Pain Phys. 2018;21(3):219–28.
  25. Webster LR, Fine PG. Review and critique of opioid rotation practices and associated risks of toxicity. Pain Med. 2012;13(4):562–70. [PMID: 22458884]
  26. Nielsen S, Degenhardt L, Hoban B, Gisev N (2014) Comparing opioids: a guide to estimating oral morphine equivalents (OME) in research. Sidney: National Drug and Alcohol Research Centre, University of NSW. Contract No.: 329
  27. Stanos S. Evolution of opioid risk management and review of the classwide REMS for extended-release/long-acting opioids. Phys Sportsmed. 2012;40(4):12–20. [PMID: 23306411]
  28. Health Quality Ontario. 9 Million prescriptions: what we know about the growing use of prescription opioids in Ontario. Toronto: Queen’s Printer for Ontario; 2017.
  29. Gomes T, Pasricha S, Martins D, Greaves S, Tadrous M, Bandola D, et al. Behind the prescriptions: a snapshot of opioid use across all Ontarians. Toronto: Ontario Drug Policy Research Network; 2017 August 22. p. 2017.
  30. Dhalla IA, Persaud N, Juurlink DN. Facing up to the prescription opioid crisis. BMJ. 2011;343:d5142. [PMID: 21862533]
  31. Coyle DT, Pratt C-Y, Ocran-Appiah J, Secora A, Kornegay C, Staffa J. Opioid analgesic dose and the risk of misuse, overdose, and death: a narrative review. Pharmacoepidemiol Drug Saf. 2018;27(5):464–72. [PMID: 29243305]
  32. Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, et al. Guideline for opioid therapy and chronic noncancer pain. Can Med Assoc J. 2017;189(18):E659–66.
  33. Spooner L, Fernandes K, Martins D, Juurlink D, Mamdani M, Paterson JM, et al. High-dose opioid prescribing and opioid-related hospitalization: a population-based study. PLoS ONE. 2016;11(12):e0167479. [PMID: 27973601]
  34. Gomes T, Juurlink DN, Dhalla IA, Mailis-Gagnon A, Paterson JM, Mamdani MM. Trends in opioid use and dosing among socio-economically disadvantaged patients. Open Med. 2011;5(1):e13–22. [PMID: 22046214]
  35. Public Health Ontario. Interactive Opioid Tool: Opioid-related morbidity and mortality in Ontario Toronto, ON: Queen’s Printer for Ontario: Ontario Agency for Health Protection and Promotion; 2020. Available from: https://www.publichealthontario.ca/en/data-and-analysis/substance-use/interactive-opioid-tool . Accessed 30 Aug 2020
  36. Gomes T, Khuu W, Martins D, Tadrous M, Mamdani MM, Paterson JM, et al. Contributions of prescribed and non-prescribed opioids to opioid related deaths: population-based cohort study in Ontario. Can BMJ. 2018;362:k3207. [PMID: 30158106]
  37. Fischer B, Jones W, Murphy Y, Ialomiteanu A, Rehm J. Recent developments in prescription opioid-related dispensing and harm indicators in Ontario. Can Pain Phys. 2015;18(4):E659–62.
  38. Ali S, Tahir B, Jabeen S, Malik M. Methadone treatment of opiate addiction: a systematic review of comparative studies. Innov Clin Neurosci. 2017;14(7–8):8–19. [PMID: 29616150]
  39. Fischer B, Jones W, Varatharajan T, Malta M, Kurdyak P. Correlations between population-levels of prescription opioid dispensing and related deaths in Ontario (Canada), 2005–2016. Prev Med. 2018;116:112–8. [PMID: 30217407]
  40. King NB, Fraser V, Boikos C, Richardson R, Harper S. Determinants of increased opioid-related mortality in the United States and Canada, 1990–2013: a systematic review. Am J Public Health. 2014;104(8):e32–42. [PMID: 24922138]
  41. Sauber-Schatz EK, Mack KA, Diekman ST, Paulozzi LJ. Associations between pain clinic density and distributions of opioid pain relievers, drug-related deaths, hospitalizations, emergency department visits, and neonatal abstinence syndrome in Florida. Drug Alcohol Depend. 2013;133(1):161–6. [PMID: 23769424]
  42. Heyward J, Olson L, Sharfstein JM, Stuart EA, Lurie P, Alexander GC. Evaluation of the extended-release/long-acting opioid prescribing risk evaluation and mitigation strategy program by the US food and drug administration: a review. JAMA Internal Med. 2020;180(2):301–9.
  43. Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. JAMA. 2016;315(22):2415–23. [PMID: 27299617]
  44. Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, et al. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;1(10):1.
  45. Dasgupta N, Funk MJ, Proescholdbell S, Hirsch A, Ribisl KM, Marshall S. Cohort study of the impact of high-dose opioid analgesics on overdose mortality. Pain Med. 2016;17(1):85–98. [PMID: 26333030]
  46. Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a national institutes of health pathways to prevention workshop. Ann Intern Med. 2015;162(4):276–86. [PMID: 25581257]
  47. Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, et al. Opioid prescriptions for chronic pain and overdose. Ann Intern Med. 2010;152(2):85–92. [PMID: 20083827]
  48. Fischer B, Jones W, Urbanoski K, Skinner R, Rehm J. Correlations between prescription opioid analgesic dispensing levels and related mortality and morbidity in Ontario, Canada, 2005–2011. Drug Alcohol Rev. 2014;33(1):19–26. [PMID: 24261474]
  49. Gomes T, Juurlink D, Yao Z, Camacho X, Paterson JM, Singh S, et al. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis. CMAJ Open. 2014;2(4):E256–61. [PMID: 25485251]
  50. Fischer B, Jones W, Rehm J. Trends and changes in prescription opioid analgesic dispensing in Canada 2005–2012: an update with a focus on recent interventions. BMC Health Serv Res. 2014;14(1):90. [PMID: 24572005]
  51. Fischer B, Jones W, Tyndall M, Kurdyak P. Correlations between opioid mortality increases related to illicit/synthetic opioids and reductions of medical opioid dispensing—exploratory analyses from Canada. BMC Public Health. 2020;20(1):143. [PMID: 32005211]
  52. Mars SG, Rosenblum D, Ciccarone D. Illicit fentanyls in the opioid street market: desired or imposed? Addiction. 2019;114(5):774–80. [PMID: 30512204]
  53. Fischer B, Pang M, Jones W. The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis? Substance abuse treatment. Prev Policy. 2020;15(1):14.
  54. Government of Canada. Opioid-related harms in Canada. Ottawa: Public Health Agency Can; 2020. Available from: https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/data-surveillance-research.html . Accessed 30 Aug 2020.
  55. Belzak L, Halverson J. The opioid crisis in Canada: a national perspective. Health Promot Chronic Dis Prev Can. 2018;38(6):224–33. [PMID: 29911818]
  56. Gisev N, Campbell G, Lalic S, Larney S, Peacock A, Nielsen S, et al. Current opioid access, use, and problems in Australasian jurisdictions. Curr Addict Rep. 2018;5(4):464–72.
  57. Lam T, Kuhn L, Hayman J, Middleton M, Wilson J, Scott D, et al. Recent trends in heroin and pharmaceutical opioid-related harms in Victoria, Australia up to 2018. Addiction. 2020;115(2):261–9. [PMID: 31465131]
  58. Roxburgh A, Hall WD, Dobbins T, Gisev N, Burns L, Pearson S, et al. Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug Alcohol Depend. 2017;179:291–8. [PMID: 28826104]
  59. Berterame S, Erthal J, Thomas J, Fellner S, Vosse B, Clare P, et al. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet (London, England). 2016;387(10028):1644–56.
  60. Fischer B, Keates A, Bühringer G, Reimer J, Rehm J. Non-medical use of prescription opioids and prescription opioid-related harms: Why so markedly higher in North America compared to the rest of the world? Addiction. 2014;109(2):177–81. [PMID: 23692335]

Grants

  1. SAF-94814/Canadian Institutes of Health Research (CA)
Journal Article
Article has an altmetric score of 1

Word Cloud

Created with Highcharts 10.0.0opioidNewZealandmortalityOntarioNorthAmericalevelssimilarindicatorsharmsdatajurisdictionsrelatedexposureegkeyopioid-relatedcomparisonuseCanadaselectCommonwealthexperiencingunprecedentedepidemicscharacterizedexcessivepersistentlyhighmisusemorbiditydiseaseburdenRecentdiscussionsconsideredwhethermightundergoneedsexpect'opioidcrisis'TowardsinformingconsiderationsexaminecompareessentialpubliclyavailableutilizationCanadianprovinceduefactoperatepublichealthcaresystemssocio-culturalsettingsfindtwofeaturedvastlydifferentpopulationconsumptionpatternshigh-dose/long-term/high-riskprescribingknownpredictorsadverseoutcomesevidencedconcreteepidemiologicalSpecificallydeathratesalreadyapproximatelythreefoldhighercomparedbasedrecent2012differentialslikelygrownrecentlygivenmajordistinctchangespopulation-levelriskssubsequentdeathssinceBasedpresentevidenceseemneedanticipateepidemicexperiencedhoweverinterestestablishcomprehensivetimelysurveillancesystem-levelstandardinter-jurisdictionalmakescasestudystarklycontrastingscenariosdriversbehinddeservesystematicexaminationComparisonCrudePopulation-LevelIndicatorsOpioidUseRelatedHarmEpidemiologyMortalityOpioidsPolicy

Similar Articles

Cited By