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Deborah Dowell - One of the best experts on this subject based on the ideXlab platform.

  • vital signs changes in Opioid prescribing in the united states 2006 2015
    Morbidity and Mortality Weekly Report, 2017
    Co-Authors: Gery P Guy, Kun Zhang, Michele K Bohm, Jan L Losby, Brian Lewis, Randall Young, Louise B Murphy, Deborah Dowell
    Abstract:

    Prescription Opioid-related overdose deaths increased sharply during 1999-2010 in the United States in parallel with increased Opioid prescribing. CDC assessed changes in national-level and county-level Opioid prescribing during 2006-2015.CDC analyzed retail prescription data from QuintilesIMS to assess Opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015.The amount of Opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and then decreased to 640 MME per capita in 2015. Despite significant decreases, the amount of Opioids prescribed in 2015 remained approximately three times as high as in 1999 and varied substantially across the country. County-level factors associated with higher amounts of prescribed Opioids include a larger percentage of non-Hispanic whites; a higher prevalence of diabetes and arthritis; micropolitan status (i.e., town/city; nonmetro); and higher unemployment and Medicaid enrollment.Despite reductions in Opioid prescribing in some parts of the country, the amount of Opioids prescribed remains high relative to 1999 levels and varies substantially at the county-level. Given associations between Opioid prescribing, Opioid use disorder, and overdose rates, health care providers should carefully weigh the benefits and risks when prescribing Opioids outside of end-of-life care, follow evidence-based guidelines, such as CDC's Guideline for Prescribing Opioids for Chronic Pain, and consider nonOpioid therapy for chronic pain treatment. State and local jurisdictions can use these findings combined with Prescription Drug Monitoring Program data to identify areas with prescribing patterns that place patients at risk for Opioid use disorder and overdose and to target interventions with prescribers based on Opioid prescribing guidelines.

  • CDC guideline for prescribing Opioids for chronic pain-United States, 2016
    JAMA - Journal of the American Medical Association, 2016
    Co-Authors: Deborah Dowell, Tamara M. Haegerich, Roger Chou
    Abstract:

    ImportancePrimary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of Opioids for chronic pain is limited. Opioid use is associated with serious risks, including Opioid use disorder and overdose.ObjectiveTo provide recommendations about Opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.ProcessThe Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of Opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.Evidence SynthesisEvidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of Opioids for chronic pain. Opioids were associated with increased risks, including Opioid use disorder, overdose, and death, with dose-dependent effects.RecommendationsThere are 12 recommendations. Of primary importance, nonOpioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting Opioids, clinicians should establish treatment goals with patients and consider how Opioids will be discontinued if benefits do not outweigh risks. When Opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent Opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued Opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with Opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.Conclusions and RelevanceThe guideline is intended to improve communication about benefits and risks of Opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term Opioid therapy.

David N Juurlink - One of the best experts on this subject based on the ideXlab platform.

  • gabapentin Opioids and the risk of Opioid related death a population based nested case control study
    PLOS Medicine, 2017
    Co-Authors: Tara Gomes, Tony Antoniou, Michael J Paterson, David N Juurlink, Muhammad Mamdani, Wim Van Den Brink
    Abstract:

    Background Prescription Opioid use is highly associated with risk of Opioid-related death, with 1 of every 550 chronic Opioid users dying within approximately 2.5 years of their first Opioid prescription. Although gabapentin is widely perceived as safe, drug-induced respiratory depression has been described when gabapentin is used alone or in combination with other medications. Because gabapentin and Opioids are both commonly prescribed for pain, the likelihood of co-prescription is high. However, no published studies have examined whether concomitant gabapentin therapy is associated with an increased risk of accidental Opioid-related death in patients receiving Opioids. The objective of this study was to investigate whether co-prescription of Opioids and gabapentin is associated with an increased risk of accidental Opioid-related mortality. Methods and findings We conducted a population-based nested case–control study among Opioid users who were residents of Ontario, Canada, between August 1, 1997, and December 31, 2013, using administrative databases. Cases, defined as Opioid users who died of an Opioid-related cause, were matched with up to 4 controls who also used Opioids on age, sex, year of index date, history of chronic kidney disease, and a disease risk index. After matching, we included 1,256 cases and 4,619 controls. The primary exposure was concomitant gabapentin use in the 120 days preceding the index date. A secondary analysis characterized gabapentin dose as low (<900 mg daily), moderate (900 to 1,799 mg daily), or high (≥1,800 mg daily). A sensitivity analysis examined the effect of concomitant nonsteroidal anti-inflammatory drug (NSAID) use in the preceding 120 days. Overall, 12.3% of cases (155 of 1,256) and 6.8% of controls (313 of 4,619) were prescribed gabapentin in the prior 120 days. After multivariable adjustment, co-prescription of Opioids and gabapentin was associated with a significantly increased odds of Opioid-related death (odds ratio [OR] 1.99, 95% CI 1.61 to 2.47, p < 0.001; adjusted OR [aOR] 1.49, 95% CI 1.18 to 1.88, p < 0.001) compared to Opioid prescription alone. In the dose–response analysis, moderate-dose (OR 2.05, 95% CI 1.46 to 2.87, p < 0.001; aOR 1.56, 95% CI 1.06 to 2.28, p = 0.024) and high-dose (OR 2.20, 95% CI 1.58 to 3.08, p < 0.001; aOR 1.58, 95% CI 1.09 to 2.27, p = 0.015) gabapentin use was associated with a nearly 60% increase in the odds of Opioid-related death relative to no concomitant gabapentin use. As expected, we found no significant association between co-prescription of Opioids and NSAIDs and Opioid-related death (OR 1.11, 95% CI 0.98 to 1.27, p = 0.113; aOR 1.14, 95% CI 0.98 to 1.32, p = 0.083). In an exploratory analysis of patients at risk of combined Opioid and gabapentin use, we found that 46.0% (45,173 of 98,288) of gabapentin users in calendar year 2013 received at least 1 concomitant prescription for an Opioid. This study was limited to individuals eligible for public drug coverage in Ontario, we were only able to identify prescriptions reimbursed by the government and dispensed from retail pharmacies, and information on indication for gabapentin use was not available. Furthermore, as with all observational studies, confounding due to unmeasured variables is a potential source of bias. Conclusions In this study we found that among patients receiving prescription Opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of Opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and, when the combination is deemed necessary, should closely monitor their patients and adjust Opioid dose accordingly. Future research should investigate whether a similar interaction exists between pregabalin and Opioids.

  • the burden of premature Opioid related mortality
    Addiction, 2014
    Co-Authors: Tara Gomes, Michael J Paterson, Muhammad Mamdani, Irfan A. Dhalla, Stephen Cornish, David N Juurlink
    Abstract:

    Background and Aims The burden of premature mortality due to Opioid-related death has not been fully characterized. We calculated temporal trends in the proportion of deaths attributable to Opioids and estimated years of potential life lost (YLL) due to Opioid-related mortality in Ontario, Canada. Design Cross-sectional study. Setting Ontario, Canada. Participants Individuals who died of Opioid-related causes between January 1991 and December 2010. Measurements We used the Registered Persons Database and data abstracted from the Office of the Chief Coroner to measure annual rates of Opioid-related mortality. The proportion of all deaths related to Opioids was determined by age group in each of 1992, 2001 and 2010. The YLL due to Opioid-related mortality were estimated, applying the life expectancy estimates for the Ontario population. Findings We reviewed 5935 Opioid-related deaths in Ontario between 1991 and 2010. The overall rate of Opioid-related mortality increased by 242% between 1991 (12.2 per 1 000 000 Ontarians) and 2010 (41.6 per 1 000 000 Ontarians; P < 0.0001). Similarly, the annual YLL due to premature Opioid-related death increased threefold, from 7006 years (1.3 years per 1000 population) in 1992 to 21 927 years (3.3 years per 1000 population) in 2010. The proportion of deaths attributable to Opioids increased significantly over time within each age group (P < 0.05). By 2010, nearly one of every eight deaths (12.1%) among individuals aged 25–34 years was Opioid-related. Conclusions Rates of Opioid-related deaths are increasing rapidly in Ontario, Canada, and are concentrated among the young, leading to a substantial burden of disease.

  • Opioid dose and drug related mortality in patients with nonmalignant pain
    JAMA Internal Medicine, 2011
    Co-Authors: Tara Gomes, Michael J Paterson, Muhammad Mamdani, Irfan A. Dhalla, David N Juurlink
    Abstract:

    Background Opioids are widely prescribed for chronic nonmalignant pain, often at doses exceeding those recommended in clinical practice guidelines. However, the risk-benefit ratio of high-dose Opioid therapy is not well characterized. The objective of this study was to characterize the relationship between Opioid dose and Opioid-related mortality. Methods We conducted a population-based nested case-control study of Ontario, Canada, residents aged 15 to 64 years who were eligible for publicly funded prescription drug coverage and had received an Opioid from August 1, 1997, through December 31, 2006, for nonmalignant pain. The outcome of interest was Opioid-related death, as determined by the investigating coroner. The risk of Opioid-related death was compared among patients treated with various daily doses of Opioids. Results Among 607 156 people aged 15 to 64 years prescribed an Opioid over the study period, we identified 498 eligible patients whose deaths were related to Opioids and 1714 matched controls. After extensive multivariable adjustment, we found that an average daily dose of 200 mg or more of morphine (or equivalent), was associated with a nearly 3-fold increase in the risk of Opioid-related mortality (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.79-4.63) relative to low daily doses ( Conclusion Among patients receiving Opioids for nonmalignant pain, the daily dose is strongly associated with Opioid-related mortality, particularly at doses exceeding thresholds recommended in recent clinical guidelines.

Tara Gomes - One of the best experts on this subject based on the ideXlab platform.

  • gabapentin Opioids and the risk of Opioid related death a population based nested case control study
    PLOS Medicine, 2017
    Co-Authors: Tara Gomes, Tony Antoniou, Michael J Paterson, David N Juurlink, Muhammad Mamdani, Wim Van Den Brink
    Abstract:

    Background Prescription Opioid use is highly associated with risk of Opioid-related death, with 1 of every 550 chronic Opioid users dying within approximately 2.5 years of their first Opioid prescription. Although gabapentin is widely perceived as safe, drug-induced respiratory depression has been described when gabapentin is used alone or in combination with other medications. Because gabapentin and Opioids are both commonly prescribed for pain, the likelihood of co-prescription is high. However, no published studies have examined whether concomitant gabapentin therapy is associated with an increased risk of accidental Opioid-related death in patients receiving Opioids. The objective of this study was to investigate whether co-prescription of Opioids and gabapentin is associated with an increased risk of accidental Opioid-related mortality. Methods and findings We conducted a population-based nested case–control study among Opioid users who were residents of Ontario, Canada, between August 1, 1997, and December 31, 2013, using administrative databases. Cases, defined as Opioid users who died of an Opioid-related cause, were matched with up to 4 controls who also used Opioids on age, sex, year of index date, history of chronic kidney disease, and a disease risk index. After matching, we included 1,256 cases and 4,619 controls. The primary exposure was concomitant gabapentin use in the 120 days preceding the index date. A secondary analysis characterized gabapentin dose as low (<900 mg daily), moderate (900 to 1,799 mg daily), or high (≥1,800 mg daily). A sensitivity analysis examined the effect of concomitant nonsteroidal anti-inflammatory drug (NSAID) use in the preceding 120 days. Overall, 12.3% of cases (155 of 1,256) and 6.8% of controls (313 of 4,619) were prescribed gabapentin in the prior 120 days. After multivariable adjustment, co-prescription of Opioids and gabapentin was associated with a significantly increased odds of Opioid-related death (odds ratio [OR] 1.99, 95% CI 1.61 to 2.47, p < 0.001; adjusted OR [aOR] 1.49, 95% CI 1.18 to 1.88, p < 0.001) compared to Opioid prescription alone. In the dose–response analysis, moderate-dose (OR 2.05, 95% CI 1.46 to 2.87, p < 0.001; aOR 1.56, 95% CI 1.06 to 2.28, p = 0.024) and high-dose (OR 2.20, 95% CI 1.58 to 3.08, p < 0.001; aOR 1.58, 95% CI 1.09 to 2.27, p = 0.015) gabapentin use was associated with a nearly 60% increase in the odds of Opioid-related death relative to no concomitant gabapentin use. As expected, we found no significant association between co-prescription of Opioids and NSAIDs and Opioid-related death (OR 1.11, 95% CI 0.98 to 1.27, p = 0.113; aOR 1.14, 95% CI 0.98 to 1.32, p = 0.083). In an exploratory analysis of patients at risk of combined Opioid and gabapentin use, we found that 46.0% (45,173 of 98,288) of gabapentin users in calendar year 2013 received at least 1 concomitant prescription for an Opioid. This study was limited to individuals eligible for public drug coverage in Ontario, we were only able to identify prescriptions reimbursed by the government and dispensed from retail pharmacies, and information on indication for gabapentin use was not available. Furthermore, as with all observational studies, confounding due to unmeasured variables is a potential source of bias. Conclusions In this study we found that among patients receiving prescription Opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of Opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and, when the combination is deemed necessary, should closely monitor their patients and adjust Opioid dose accordingly. Future research should investigate whether a similar interaction exists between pregabalin and Opioids.

  • the burden of premature Opioid related mortality
    Addiction, 2014
    Co-Authors: Tara Gomes, Michael J Paterson, Muhammad Mamdani, Irfan A. Dhalla, Stephen Cornish, David N Juurlink
    Abstract:

    Background and Aims The burden of premature mortality due to Opioid-related death has not been fully characterized. We calculated temporal trends in the proportion of deaths attributable to Opioids and estimated years of potential life lost (YLL) due to Opioid-related mortality in Ontario, Canada. Design Cross-sectional study. Setting Ontario, Canada. Participants Individuals who died of Opioid-related causes between January 1991 and December 2010. Measurements We used the Registered Persons Database and data abstracted from the Office of the Chief Coroner to measure annual rates of Opioid-related mortality. The proportion of all deaths related to Opioids was determined by age group in each of 1992, 2001 and 2010. The YLL due to Opioid-related mortality were estimated, applying the life expectancy estimates for the Ontario population. Findings We reviewed 5935 Opioid-related deaths in Ontario between 1991 and 2010. The overall rate of Opioid-related mortality increased by 242% between 1991 (12.2 per 1 000 000 Ontarians) and 2010 (41.6 per 1 000 000 Ontarians; P < 0.0001). Similarly, the annual YLL due to premature Opioid-related death increased threefold, from 7006 years (1.3 years per 1000 population) in 1992 to 21 927 years (3.3 years per 1000 population) in 2010. The proportion of deaths attributable to Opioids increased significantly over time within each age group (P < 0.05). By 2010, nearly one of every eight deaths (12.1%) among individuals aged 25–34 years was Opioid-related. Conclusions Rates of Opioid-related deaths are increasing rapidly in Ontario, Canada, and are concentrated among the young, leading to a substantial burden of disease.

  • Opioid dose and drug related mortality in patients with nonmalignant pain
    JAMA Internal Medicine, 2011
    Co-Authors: Tara Gomes, Michael J Paterson, Muhammad Mamdani, Irfan A. Dhalla, David N Juurlink
    Abstract:

    Background Opioids are widely prescribed for chronic nonmalignant pain, often at doses exceeding those recommended in clinical practice guidelines. However, the risk-benefit ratio of high-dose Opioid therapy is not well characterized. The objective of this study was to characterize the relationship between Opioid dose and Opioid-related mortality. Methods We conducted a population-based nested case-control study of Ontario, Canada, residents aged 15 to 64 years who were eligible for publicly funded prescription drug coverage and had received an Opioid from August 1, 1997, through December 31, 2006, for nonmalignant pain. The outcome of interest was Opioid-related death, as determined by the investigating coroner. The risk of Opioid-related death was compared among patients treated with various daily doses of Opioids. Results Among 607 156 people aged 15 to 64 years prescribed an Opioid over the study period, we identified 498 eligible patients whose deaths were related to Opioids and 1714 matched controls. After extensive multivariable adjustment, we found that an average daily dose of 200 mg or more of morphine (or equivalent), was associated with a nearly 3-fold increase in the risk of Opioid-related mortality (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.79-4.63) relative to low daily doses ( Conclusion Among patients receiving Opioids for nonmalignant pain, the daily dose is strongly associated with Opioid-related mortality, particularly at doses exceeding thresholds recommended in recent clinical guidelines.

Bradley C Martin - One of the best experts on this subject based on the ideXlab platform.

  • characteristics of initial prescription episodes and likelihood of long term Opioid use united states 2006 2015
    Morbidity and Mortality Weekly Report, 2017
    Co-Authors: A B Shah, Corey J Hayes, Bradley C Martin
    Abstract:

    Because long-term Opioid use often begins with treatment of acute pain (1), in March 2016, the CDC Guideline for Prescribing Opioids for Chronic Pain included recommendations for the duration of Opioid therapy for acute pain and the type of Opioid to select when therapy is initiated (2). However, data quantifying the transition from acute to chronic Opioid use are lacking. Patient records from the IMS Lifelink+ database were analyzed to characterize the first episode of Opioid use among commercially insured, Opioid-naive, cancer-free adults and quantify the increase in probability of long-term use of Opioids with each additional day supplied, day of therapy, or incremental increase in cumulative dose. The largest increments in probability of continued use were observed after the fifth and thirty-first days on therapy; the second prescription; 700 morphine milligram equivalents cumulative dose; and first prescriptions with 10- and 30-day supplies. By providing quantitative evidence on risk for long-term use based on initial prescribing characteristics, these findings might inform Opioid prescribing practices. Language: en

  • the role of Opioid prescription in incident Opioid abuse and dependence among individuals with chronic non cancer pain the role of Opioid prescription
    The Clinical Journal of Pain, 2013
    Co-Authors: Mark J Edlund, Bradley C Martin, Joan Russo, Andrea Devries, Jennifer Brennan Braden, Mark D. Sullivan
    Abstract:

    Objective Increasing rates of Opioid use disorders (abuse and dependence) among patients prescribed Opioids are a significant public health concern. We investigated the association between exposure to prescription Opioids and incident Opioid use disorders (OUDs) among individuals with a new episode of a chronic non-cancer pain (CNCP) condition.

Michael J Paterson - One of the best experts on this subject based on the ideXlab platform.

  • gabapentin Opioids and the risk of Opioid related death a population based nested case control study
    PLOS Medicine, 2017
    Co-Authors: Tara Gomes, Tony Antoniou, Michael J Paterson, David N Juurlink, Muhammad Mamdani, Wim Van Den Brink
    Abstract:

    Background Prescription Opioid use is highly associated with risk of Opioid-related death, with 1 of every 550 chronic Opioid users dying within approximately 2.5 years of their first Opioid prescription. Although gabapentin is widely perceived as safe, drug-induced respiratory depression has been described when gabapentin is used alone or in combination with other medications. Because gabapentin and Opioids are both commonly prescribed for pain, the likelihood of co-prescription is high. However, no published studies have examined whether concomitant gabapentin therapy is associated with an increased risk of accidental Opioid-related death in patients receiving Opioids. The objective of this study was to investigate whether co-prescription of Opioids and gabapentin is associated with an increased risk of accidental Opioid-related mortality. Methods and findings We conducted a population-based nested case–control study among Opioid users who were residents of Ontario, Canada, between August 1, 1997, and December 31, 2013, using administrative databases. Cases, defined as Opioid users who died of an Opioid-related cause, were matched with up to 4 controls who also used Opioids on age, sex, year of index date, history of chronic kidney disease, and a disease risk index. After matching, we included 1,256 cases and 4,619 controls. The primary exposure was concomitant gabapentin use in the 120 days preceding the index date. A secondary analysis characterized gabapentin dose as low (<900 mg daily), moderate (900 to 1,799 mg daily), or high (≥1,800 mg daily). A sensitivity analysis examined the effect of concomitant nonsteroidal anti-inflammatory drug (NSAID) use in the preceding 120 days. Overall, 12.3% of cases (155 of 1,256) and 6.8% of controls (313 of 4,619) were prescribed gabapentin in the prior 120 days. After multivariable adjustment, co-prescription of Opioids and gabapentin was associated with a significantly increased odds of Opioid-related death (odds ratio [OR] 1.99, 95% CI 1.61 to 2.47, p < 0.001; adjusted OR [aOR] 1.49, 95% CI 1.18 to 1.88, p < 0.001) compared to Opioid prescription alone. In the dose–response analysis, moderate-dose (OR 2.05, 95% CI 1.46 to 2.87, p < 0.001; aOR 1.56, 95% CI 1.06 to 2.28, p = 0.024) and high-dose (OR 2.20, 95% CI 1.58 to 3.08, p < 0.001; aOR 1.58, 95% CI 1.09 to 2.27, p = 0.015) gabapentin use was associated with a nearly 60% increase in the odds of Opioid-related death relative to no concomitant gabapentin use. As expected, we found no significant association between co-prescription of Opioids and NSAIDs and Opioid-related death (OR 1.11, 95% CI 0.98 to 1.27, p = 0.113; aOR 1.14, 95% CI 0.98 to 1.32, p = 0.083). In an exploratory analysis of patients at risk of combined Opioid and gabapentin use, we found that 46.0% (45,173 of 98,288) of gabapentin users in calendar year 2013 received at least 1 concomitant prescription for an Opioid. This study was limited to individuals eligible for public drug coverage in Ontario, we were only able to identify prescriptions reimbursed by the government and dispensed from retail pharmacies, and information on indication for gabapentin use was not available. Furthermore, as with all observational studies, confounding due to unmeasured variables is a potential source of bias. Conclusions In this study we found that among patients receiving prescription Opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of Opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and, when the combination is deemed necessary, should closely monitor their patients and adjust Opioid dose accordingly. Future research should investigate whether a similar interaction exists between pregabalin and Opioids.

  • the burden of premature Opioid related mortality
    Addiction, 2014
    Co-Authors: Tara Gomes, Michael J Paterson, Muhammad Mamdani, Irfan A. Dhalla, Stephen Cornish, David N Juurlink
    Abstract:

    Background and Aims The burden of premature mortality due to Opioid-related death has not been fully characterized. We calculated temporal trends in the proportion of deaths attributable to Opioids and estimated years of potential life lost (YLL) due to Opioid-related mortality in Ontario, Canada. Design Cross-sectional study. Setting Ontario, Canada. Participants Individuals who died of Opioid-related causes between January 1991 and December 2010. Measurements We used the Registered Persons Database and data abstracted from the Office of the Chief Coroner to measure annual rates of Opioid-related mortality. The proportion of all deaths related to Opioids was determined by age group in each of 1992, 2001 and 2010. The YLL due to Opioid-related mortality were estimated, applying the life expectancy estimates for the Ontario population. Findings We reviewed 5935 Opioid-related deaths in Ontario between 1991 and 2010. The overall rate of Opioid-related mortality increased by 242% between 1991 (12.2 per 1 000 000 Ontarians) and 2010 (41.6 per 1 000 000 Ontarians; P < 0.0001). Similarly, the annual YLL due to premature Opioid-related death increased threefold, from 7006 years (1.3 years per 1000 population) in 1992 to 21 927 years (3.3 years per 1000 population) in 2010. The proportion of deaths attributable to Opioids increased significantly over time within each age group (P < 0.05). By 2010, nearly one of every eight deaths (12.1%) among individuals aged 25–34 years was Opioid-related. Conclusions Rates of Opioid-related deaths are increasing rapidly in Ontario, Canada, and are concentrated among the young, leading to a substantial burden of disease.

  • Opioid dose and drug related mortality in patients with nonmalignant pain
    JAMA Internal Medicine, 2011
    Co-Authors: Tara Gomes, Michael J Paterson, Muhammad Mamdani, Irfan A. Dhalla, David N Juurlink
    Abstract:

    Background Opioids are widely prescribed for chronic nonmalignant pain, often at doses exceeding those recommended in clinical practice guidelines. However, the risk-benefit ratio of high-dose Opioid therapy is not well characterized. The objective of this study was to characterize the relationship between Opioid dose and Opioid-related mortality. Methods We conducted a population-based nested case-control study of Ontario, Canada, residents aged 15 to 64 years who were eligible for publicly funded prescription drug coverage and had received an Opioid from August 1, 1997, through December 31, 2006, for nonmalignant pain. The outcome of interest was Opioid-related death, as determined by the investigating coroner. The risk of Opioid-related death was compared among patients treated with various daily doses of Opioids. Results Among 607 156 people aged 15 to 64 years prescribed an Opioid over the study period, we identified 498 eligible patients whose deaths were related to Opioids and 1714 matched controls. After extensive multivariable adjustment, we found that an average daily dose of 200 mg or more of morphine (or equivalent), was associated with a nearly 3-fold increase in the risk of Opioid-related mortality (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.79-4.63) relative to low daily doses ( Conclusion Among patients receiving Opioids for nonmalignant pain, the daily dose is strongly associated with Opioid-related mortality, particularly at doses exceeding thresholds recommended in recent clinical guidelines.