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. 2014 Aug;104(8):e32-42.
doi: 10.2105/AJPH.2014.301966. Epub 2014 Jun 12.

Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review

Nicholas B King  1 , Veronique Fraser, Constantina Boikos, Robin Richardson, Sam Harper
Affiliations

Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review

Nicholas B King et al. Am J Public Health. 2014 Aug.

Abstract

We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013. We identified 17 determinants of opioid-related mortality and mortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult. Preventing additional opioid-related mortality will likely require interventions that address multiple determinants and are tailored to specific locations and populations.

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FIGURE 1—
FIGURE 1—
Flow diagram of systematic review.
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Comment in

  • Disposing of medicines safely.
    Fain KM, Alexander GC. Fain KM, et al. Am J Public Health. 2014 Dec;104(12):e2-3. doi: 10.2105/AJPH.2014.302296. Epub 2014 Oct 16. Am J Public Health. 2014. PMID: 25320887 Free PMC article. No abstract available.

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