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. 2020 Aug 31;15(1):66.
doi: 10.1186/s13011-020-00308-z.

Recent changes in trends of opioid overdose deaths in North America

Sameer Imtiaz  1 , Kevin D Shield  2   3 , Benedikt Fischer  4   5   6   7 , Tara Elton-Marshall  2   3   8   9 , Bundit Sornpaisarn  2 , Charlotte Probst  2 , Jürgen Rehm  2   3   4   5   10   11   12
Affiliations

Recent changes in trends of opioid overdose deaths in North America

Sameer Imtiaz et al. Subst Abuse Treat Prev Policy. .

Abstract

Background: As several regulatory and environmental changes have occurred in North America, trends in overdose deaths were examined in the United States (US), Ontario and British Columbia (BC), including changes in consumption levels of prescription opioids (PO) and overdose deaths, changes in correlations between consumption levels of PO and overdose deaths and modeled differences between observed and predicted overdose deaths if no changes had occurred.

Methods: Consumption levels of PO included defined daily doses for statistical purposes per million inhabitants per day for the US and Canada (2001-2015). Overdose deaths included opioid overdose deaths for the US (2001-2017) and Ontario (2003-2017) and illicit drug overdose deaths for BC (2001-2017). The analytic techniques included structural break point analyses, Pearson product-moment correlations and multivariate Gaussian state space modeling.

Results: Consumption levels of PO changed in the US in 2010 and in Canada in 2012. Overdose deaths changed in the US in 2014 and in Ontario and BC in 2015. Prior to the observed changes in consumption levels of PO, there were positive correlations between consumption levels of PO and overdose deaths in the US (r = 0.99, p < 0.001) and Ontario (r = 0.92, p = 0.003). After the observed changes in consumption levels of PO, there was a negative correlation between consumption levels of PO and overdose deaths in the US (r = - 0.99, p = 0.002). Observed overdose deaths exceeded predicted overdose deaths by 5.7 (95% Confidence Interval [CI]: 4.8-6.6), 3.5 (95% CI: 3.2-3.8) and 21.8 (95% CI: 18.6-24.9) deaths per 100,000 people in the US, Ontario and BC, respectively in 2017. These excess deaths corresponded to 37.7% (95% CI: 31.9-43.6), 39.2% (95% CI: 36.3-42.1) and 72.2% (95% CI: 61.8-82.6) of observed overdose deaths in the US, Ontario and BC, respectively in 2017.

Conclusions: The opioid crisis has evolved in North America, as a sizeable proportion of overdose deaths are now attributable to the several regulatory and environmental changes. These findings necessitate substance use policies to be conceptualized more broadly as well as the continued expansion of harm reduction services and types of pharmacotherapy interventions.

Keywords: Analgesics, opioid; British Columbia; Canada; Death; Drug overdose; Ontario; Prescription drug; United States.

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Conflict of interest statement

Jürgen Rehm has received grants and personal fees from Lundbeck, unrelated to the present research. All other authors declare declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Defined daily doses for statistical purposes per million inhabitants per day of prescription opioids
Fig. 2
Fig. 2
Observed and predicted overdose deaths assuming no regulatory or environmental changes
See this image and copyright information in PMC

References

    1. National Institute on Drug Abuse . Overdose death rates - revised august 2018. Washington, District of Columbia: National Institute on Drug Abuse; 2018.
    1. Special Advisory Committee on the Epidemic of Opioid Overdoses . National report: Apparent opioid-related deaths in Canada (January 2016 to December 2018) Web-based report. Ottawa, Ontario: Public Health Agency of Canada; 2019.
    1. Centers for Disease Control and Prevention . 2018 Annual surveillance report of drug-related risks and outcomes: United States. Atlanta, Georgia: Centers for Disease Control and Prevention; 2018.
    1. 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, Canada. BMJ. 2018;362:k3207. - PMC - PubMed
    1. Dart RC, Severtson SG, Bucher-Bartelson B. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(16):1573–1574. - PubMed

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