Short communicationChanges in and characteristics of admissions to treatment related to problematic prescription opioid use in Ontario, 2004–2009
Section snippets
Background
Prescription opioid analgesics (POs) are potent psychoactive medications, used primarily for the treatment of severe and/or chronic pain (Ballantyne and Mao, 2003, Hariharan et al., 2007). North America is the region with by far the highest PO consumption globally (International Narcotics Control Board, 2008). Specifically, the US consumed 40,604 Standard Daily Defined Doses [S-DDD] of PO medications per million residents in the period 2005–2007; the corresponding rate in Canada was 18,914 (
Methods
This study involves secondary analysis of client-level administrative data from the Drug and Alcohol Treatment Information System (DATIS), the reporting system for publicly funded addiction treatment services in the province of Ontario (Rush, 2002). DATIS covers data from approximately 150 agencies, which deliver a mix of assessment and referral, outpatient, residential treatment, and withdrawal management services. Private, self-help, or pharmaco-therapeutic (e.g., opioid maintenance)
Results
A total of 500,217 cases were registered in DATIS in the observation period, representing 319,898 clients. Over the full five years combined, the prevalence of problematic PO use was 12.3% at the case-level (N = 61,509). The prevalence of problematic PO use in the full DATIS caseload increased steadily from 9.4% in 2004–2005 to 15.7% in 2008–2009 (see Table 1). While the total number of males seeking treatment for PO-related problems exceeded the total number of females, the proportion of female
Discussion
This study examined trends in the caseload and described socio-clinical characteristics of clients reporting problematic PO use in the publicly funded addiction treatment system in Ontario between 2004 and 2009.
The number of PO-related treatment admissions in Ontario almost doubled in the observation period, while the proportion of PO-related cases among all treatment admissions rose by 60%. Importantly, DATIS does not cover admissions to OMT (e.g., methadone or buprenorphine), the treatment
Conflict of interest
Nothing to declare.
Role of funding source
Dr. Fischer acknowledges project and salary funding support from the Canadian Institutes of Health Research (CIHR), including a CIHR/PHAC Research Chair in Applied Public Health, and a MSFHR Senior Scholar Award. Drs. Fischer, Rehm, Rush and Ms. Urbanoski acknowledge funding support from the Ministry of Health and Long-Term Care (MoHLTC) of Ontario.
Contributors
We declare that all authors (Fischer, Nakamura, Rush, Rehm and Urbanoski) contributed substantially to conception and design of the study; contributed substantially to the analysis and interpretation of data; contributed to drafting and revising the article for critically important intellectual content; and gave final approval of the version to be published.
References (37)
- et al.
Prescription opioid abuse in patients presenting for methadone maintenance treatment
Drug and Alcohol Dependence
(2004) - et al.
Developing a national addiction treatment information system. The drug and alcohol program treatment inventory
Journal of Substance Abuse Treatment
(1999) - et al.
Assessing the need for substance abuse services: a critical review of needs assessment models
Evaluation and Program Planning
(1996) - et al.
Consensus statement on office-based treatment of opioid dependence using buprenorphine
Journal of Substance Abuse Treatment
(2004) - et al.
A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control
Journal of Pain and Symptom Management
(2004) - et al.
Alcohol and public health: a review
The Lancet
(2005) - et al.
Prescription opioid abuse among enrollees into methadone maintenance treatment
Drug and Alcohol Dependence
(2007) - et al.
College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement
Drug and Alcohol Dependence
(2003) - et al.
Drug Use Among Ontarion Students: Detailed OSDUHS Findings: 1977–2007
(2007) - et al.
Alcohol: No Ordinary Commodity. Research and Public Policy
(2003)
Opioid therapy for chronic pain
The New England Journal of Medicine
Opioid analgesic prescribing and mortality before and after the introduction of long-acting oxycodone in Ontario
Canadian Medical Association Journal
Comparing injecting and non-injecting illicit opioid users in a multisite Canadian sample (OPICAN cohort)
European Addiction Research
Changes in illicit opioid use profiles across Canada
Canadian Medical Association Journal
Characterizing the ‘awakening elephant’: prescription opioid misuse in North America: epidemiology, harms, interventions
Contemporary Drug Problems
Non-medical use of prescription opioids and public health in Canada: an urgent call for research and interventions development
Canadian Journal of Public Health
The social epidemiology of substance use
Epidemiologic Reviews
Long-term opioid contract use for chronic pain management in primary care practice. A five year experience
Journal of General Internal Medicine
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