Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada [处方与非处方阿片类药物对阿片相关死亡的贡献：基于加拿大安大略省人群的队列研究]

• 分享：

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3207 (Published 29 August 2018)
Cite this as: BMJ 2018;362:k3207

Authors
Tara Gomes, Wayne Khuu, Diana Martins, Mina Tadrous, Muhammad M Mamdani, J Michael Paterson, David N Juurlink

Abstract
Objective To describe the contributions of prescribed and non-prescribed opioids to opioid related deaths.

Design Population based cohort study.

Setting Ontario, Canada, from 1 January 2013 to 31 December 2016.

Participants All Ontarians who died of an opioid related cause.

Exposure Active opioid prescriptions, defined as those with a duration overlapping the date of death, and recent opioid prescriptions, defined as those dispensed in the 30 and 180 days preceding death. Postmortem toxicology results from the Drug and Drug/Alcohol Related Death database were used to characterise deaths on the basis of presence of prescribed and non-prescribed (that is, diverted or illicit) opioids, overall and stratified by year and age.

Results 2833 opioid related deaths occurred. An active opioid prescription on the date of death was relatively common but declined slightly throughout the study period (38.2% (241/631) in 2013 and 32.5% (278/855) in 2016; P for trend=0.03). Older people and women were relatively more likely to have an active opioid prescription at time of death. In 2016, 46% (169/364) of people aged 45-64 had an active opioid prescription compared with only 12% (8/69) among those aged 24 or younger (P for trend<0.001). Similarly, 46% (124/272) of women had an active opioid prescription at time of death compared with 26.4% (154/583) of men (P<0.001). Among people with active opioid prescriptions at time of death, 37.8% (375/993) also had evidence of a non-prescribed opioid on postmortem toxicology. By 2016, the non-prescribed opioid most commonly identified after death was fentanyl (41%; 47 of 115 cases). Among people without an active opioid prescription at time of death, fentanyl was detected in 20% (78/390) of deaths in 2013, increasing to 47.5% (274/577) by 2016 (P<0.001).

Conclusions Prescribed, diverted, and illicit opioids all play an important role in opioid related deaths. Although more than half of all opioid related deaths still involved prescription drugs (either dispensed or diverted) in 2016, the increased rate of deaths involving fentanyl between 2015 and 2016 is concerning and suggests the need for a multifactorial approach to this problem that considers both the prescribed and illicit opioid environments.