The burden of premature opioid-related mortality

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.

Keywords: Burden of disease; drug toxicity; mortality; observational epidemiology; opioid analgesics; pharmacoepidemiology.

Figure 1

Annual rate of opioid-related mortality (per 1 000 000 population) in Ontario, 1991–2010. Deaths abstracted from the Office of the Chief Coroner of Ontario were deemed opioid-related by the coroner if post-mortem toxicological analysis revealed opioid concentrations sufficiently high to cause death, or if a combination of drugs (including at least one opioid at clinically significant levels) contributed to death. Rates presented per 1 000 000 population

Figure 2

Proportion of all deaths that are opioid-related, by age group, 1992, 2001 and 2010. The proportion of deaths in each age group that involved an opioid was calculated using opioid-related death data abstracted from the Office of the Chief Coroner of Ontario and deaths from all causes identified using the Ontario Registered Persons Database. This analysis was performed at three time-points over our study period: 1992, 2001 and 2010