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Changes in and characteristics of admissions to treatment related to problematic prescription opioid use in Ontario, 2004–2009

https://doi.org/10.1016/j.drugalcdep.2010.02.001Get rights and content

Abstract

Background

North America is the region with the world's highest prescription opioid (PO) use. Non-medical use of prescription opioids and PO-related morbidity and mortality have strongly increased in the US in recent years. It is assumed that similar trends are occurring in Canada, but there is less empirical evidence to support this. Treatment demand for problematic PO use is an important indicator of PO-related morbidity.

Methods

Levels and changes related to the caseload of PO-related treatment admissions were assessed using system-level data from the Drug and Alcohol Treatment Information System (DATIS), the reporting system for publicly funded addiction treatment services in the province of Ontario (Canada) for the period April 2004–March 2009 (n = 500,217). In addition, basic socio-demographic and clinical characteristics of PO-related treatment admissions in the final year of study (n = 10,125) were examined.

Results

The number of PO-related treatment admissions in DATIS rose by 60%, and their prevalence in the total caseload increased from 9.4% to 15.7% in the study period. Three-quarters of PO-clients reported other problem substances; the most common co-occurring problem substance was cocaine/crack. The majority of PO-clients were <35 years of age, unemployed, and referred to treatment by others.

Interpretation

Demand for treatment for problematic PO use has risen substantially in Ontario in the past five years in the wider context of substantially increased overall PO use and related harms in Canada. The interaction dynamics between these different indicators need to be systematically examined and monitored as the basis for evidence-based interventions.

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.

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