Prevalence of prescribed opioid claims among persons with non-traumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study

Qi Guan^{1

2}, Mary-Ellen Hogan², Andrew Calzavara³, Daniel McCormack³, Aisha K Lofters^{3

4

5}, Tejal Patel^{6

7

8}, Sander L Hitzig^{9

10

11}, Tanya Packer^{12

13}, Sara J T Guilcher^{14

15

16

17}

Affiliations

¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
² Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
³ ICES, Toronto, ON, Canada.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Women's College Research Institute, Toronto, ON, Canada.
⁶ School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.
⁷ Schlegel - University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.
⁸ Waterloo Institute for Complexity and Innovation, University of Waterloo, Waterloo, ON, Canada.
⁹ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹¹ Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹² Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada.
¹³ Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands.
¹⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. sara.guilcher@utoronto.ca.
¹⁵ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. sara.guilcher@utoronto.ca.
¹⁶ ICES, Toronto, ON, Canada. sara.guilcher@utoronto.ca.
¹⁷ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. sara.guilcher@utoronto.ca.

PMID: 41241697
DOI: 10.1038/s41393-025-01140-7

Prevalence of prescribed opioid claims among persons with non-traumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study

Qi Guan et al. Spinal Cord. 2026 Feb.

. 2026 Feb;64(2):151-157.

doi: 10.1038/s41393-025-01140-7. Epub 2025 Nov 15.

Authors

Affiliations

¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
² Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
³ ICES, Toronto, ON, Canada.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Women's College Research Institute, Toronto, ON, Canada.
⁶ School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.
⁷ Schlegel - University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.
⁸ Waterloo Institute for Complexity and Innovation, University of Waterloo, Waterloo, ON, Canada.
⁹ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹¹ Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹² Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada.
¹³ Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands.
¹⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. sara.guilcher@utoronto.ca.
¹⁵ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. sara.guilcher@utoronto.ca.
¹⁶ ICES, Toronto, ON, Canada. sara.guilcher@utoronto.ca.
¹⁷ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. sara.guilcher@utoronto.ca.

PMID: 41241697
DOI: 10.1038/s41393-025-01140-7

Abstract

Study design: Cohort study.

Objectives: To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation.

Setting: Ontario, Canada.

Methods: We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals.

Results: We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30-40 years of age (aRR 1.54, 95% CI 1.42-1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80.

Conclusions: Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Statement of ethics: ICES is a prescribed entity under Ontario’s Personal Health Information Protection Act (PHIPA). Section 45 of PHIPA authorizes ICES to collect personal health information, without consent, for the purpose of analysis or compiling statistical information with respect to the management of, evaluation or monitoring of, the allocation of resources to or planning for all or part of the health system. Projects that use data collected by ICES under section 45 of PHIPA, and use no other data, are exempt from REB review. The use of the data in this project is authorized under section 45 and approved by ICES’ Privacy and Legal Office which does not require review by a Research Ethics Board. However, this study was approved by the Research Ethics Board of the University of Toronto. All methods were performed in accordance with the relevant guidelines and regulations.

References

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Prevalence of prescribed opioid claims among persons with non-traumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study

Affiliations

Prevalence of prescribed opioid claims among persons with non-traumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous