scholarly journals Patterns, trends and determinants of medical opioid utilization in Canada 2005–2020: characterizing an era of intensive rise and fall

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Wayne Jones ◽  
Ridhwana Kaoser ◽  
Benedikt Fischer
Keyword(s):  
Population Level ◽  
Prescription Opioid ◽  
Policy And Practice ◽  
Marked Rise ◽  
Strong Opioid ◽  
Defined Daily Doses ◽  
Care Outcomes ◽  
Opioid Medications ◽  
Strong Opioids ◽  
Over Time

Abstract Background Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005–2020. Methods Raw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for ‘strong’ and ‘weak’ opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing. Results All provinces reported starkly increasing strong opioid dispensing peaking 2011–2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of > 100 %; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control. Conclusions We characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.

scholarly journals Opioid use trends in Spain: the case of the island of La Gomera (2016–2019)

2021 ◽  
Author(s):  
Alexis Oliva ◽  
Néstor Armas ◽  
Sandra Dévora ◽  
Susana Abdala
Keyword(s):  
Population Level ◽  
Rate Of Change ◽  
Prescription Opioid ◽  
Community Pharmacies ◽  
Opioid Use ◽  
Health Area ◽  
Defined Daily Doses ◽  
Strong Opioids ◽  
Prescription Opioid Use ◽  
La Gomera

Abstract This study is an evaluation of prescription opioid use on the island of La Gomera, a mainly rural area, during the period 2016–2019 at various levels. Data were extracted from the wholesalers who supply the community pharmacies at the population level. Prescription opioid use was measured as defined daily doses per 1,000 inhabitants/day (DID) and by the number of units sold per 1,000 inhabitants and year (units sold). This provided an island total of La Gomera’s overall prescription of opioids and its rate of change, as well as differences in prescribing at the municipal and health area level. Tramadol with acetaminophen and tramadol in monotherapy were the most consumed by “units sold” parameter, which accounted for 69.48% and 18.59% of the total. The situation was similar for DID, although with lower percentages, but a significant increase was observed in the use of fentanyl and buprenorphine, around 15% in each case. The balance between the uses of weak or strong opioids was different in La Gomera compared to that of Spain as a whole. In Spain, almost 70% of the prescriptions were for weak opioids compared to 58.67% in La Gomera. Fentanyl was the most used strong opioid (16.10%) followed by tapentadol and buprenorphine, around 5% each, whereas in La Gomera, buprenorphine was the most consumed (15.75%) followed by fentanyl (14.87%) and tapentadol (5.82%). These differences in prescription opioid use are most likely explained by prescriber characteristics, whereas the population age, socioeconomic status, or living in rural/urban area are not decisive determinants.

scholarly journals Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007 - 2016

2020 ◽  
Author(s):  
Wayne Jones ◽  
Paul Kurdyak ◽  
Benedikt Fischer
Keyword(s):  
Disease Burden ◽  
Population Level ◽  
Hospitalization Rates ◽  
Defined Daily Doses ◽  
High Contribution ◽  
Stratified Sample ◽  
Hospital Morbidity ◽  
Strong Opioids ◽  
Dispensing Data ◽  
Related Mortality

Abstract Background: High levels of opioid-related mortality, as well as morbidity, contribute to the excessive opioid-related disease burden in North America, induced by high availability of opioids. While correlations between opioid dispensing levels and mortality outcomes are well-established, fewer evidence exists on correlations with morbidity (e.g., hospitalizations).Methods: We examined possible overtime correlations between medical opioid dispensing and opioid-related hospitalizations in Canada, by province, 2007 – 2016. For dispensing, we examined annual volumes of medical opioid dispensing from a representative, stratified sample of retail pharmacies across Canada. Raw dispensing information for ‘strong opioids’ was converted into Defined Daily Doses per 1,000 population per day (DDD/1,000/day). Opioid-related hospitalization rates referred to opioid poisoning-related admissions by province, for fiscal years 2007-08 to 2016-17, drawn from the national Hospital Morbidity Database. We assessed possible correlations between opioid dispensing and hospitalizations by province using the Pearson product moment correlation; correlation values (r) and confidence intervals were reported.Results: Significant correlations for overtime correlations between population-levels of opioid dispensing and opioid-related hospitalizations were observed for three provinces: Quebec (r=0.87, CI: 0.49–0.97; p=0.002); New Brunswick (r=0.85;CI: 0.43–0.97; p=0.004) and Nova Scotia (r=0.78; CI:0.25–0.95; p=0.012), with Saskatchewan (r=0.073; CI:-0.07–0.91;p=0.073) featuring borderline significance.Conclusions: The correlations observed further contribute to evidence on opioid dispensing levels as a systemic driver of population-level harms. Notably, correlations were not identified principally in provinces with reported high contribution levels (>50%) of illicit opioids to mortality, which are not captured by dispensing data and so may have distorted potential effects due to contamination.

scholarly journals Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007 - 2016

2019 ◽  
Author(s):  
Wayne Jones ◽  
Paul Kurdyak ◽  
Benedikt Fischer
Keyword(s):  
Disease Burden ◽  
Population Level ◽  
Hospitalization Rates ◽  
Defined Daily Doses ◽  
High Contribution ◽  
Stratified Sample ◽  
Hospital Morbidity ◽  
Strong Opioids ◽  
Dispensing Data ◽  
Related Mortality

Abstract Background: High levels of opioid-related mortality, as well as morbidity, contribute to the excessive opioid-related disease burden in North America, induced by high availability of opioids. While correlations between opioid dispensing levels and mortality outcomes are well-established, fewer evidence exists on correlations with morbidity (e.g., hospitalizations). Methods: We examined possible overtime correlations between medical opioid dispensing and opioid-related hospitalizations in Canada, by province, 2007 – 2016. For dispensing, we examined annual volumes of medical opioid dispensing from a representative, stratified sample of retail pharmacies across Canada. Raw dispensing information for ‘strong opioids’ was converted into Defined Daily Doses (DDD)/per 1,000 population/year. Opioid-related hospitalization rates referred to opioid poisoning-related admissions by province, for fiscal years 2007-08 to 2016-17, drawn from the national Hospital Morbidity Database. We assessed possible correlations between opioid dispensing and hospitalizations by province using the Pearson product moment correlation; correlation values (r) and confidence intervals were reported. Results: Significant correlations for overtime correlations between population-levels of opioid dispensing and opioid-related hospitalizations were observed for three provinces: Quebec (r=0.87, CI: 0.49–0.97; p=0.002); New Brunswick (r=0.85;CI: 0.43–0.97; p=0.004) and Nova Scotia (r=0.78; CI:0.25–0.95; p=0.012), with Saskatchewan (r=0.073; CI:-0.07–0.91;p=0.073) featuring borderline significance. Conclusions: The correlations observed further contribute to evidence on opioid dispensing levels as a systemic driver of population-level harms. Notably, correlations were not identified principally in provinces with reported high contribution levels (>50%) of illicit opioids to mortality, which are not captured by dispensing data and so may have distorted potential effects due to contamination.

Static metrics of impact for a dynamic problem: The need for smarter tools to guide suicide prevention planning and investment

2018 ◽  
Vol 52 (7) ◽  
pp. 660-667 ◽  
Author(s):  
Andrew Page ◽  
Jo-An Atkinson ◽  
Mark Heffernan ◽  
Geoff McDonnell ◽  
Ante Prodan ◽  
...  
Keyword(s):  
Suicide Prevention ◽  
Population Attributable Risk ◽  
Population Level ◽  
Systems Science ◽  
Evidence Based ◽  
Policy And Practice ◽  
Psychosocial Therapy ◽  
Potential Impact ◽  
Therapy Intervention ◽  
Over Time

Objectives: This study investigates two approaches to estimate the potential impact of a population-level intervention on Australian suicide, to highlight the importance of selecting appropriate analytic approaches for informing evidence-based strategies for suicide prevention. Methods: The potential impact of a psychosocial therapy intervention on the incidence of suicide in Australia over the next 10 years was used as a case study to compare the potential impact on suicides averted using: (1) a traditional epidemiological measure of population attributable risk and (2) a dynamic measure of population impact based on a systems science model of suicide that incorporates changes over time. Results: Based on the population preventive fraction, findings suggest that the psychosocial therapy intervention if implemented among all eligible individuals in the Australian population would prevent 5.4% of suicides (or 1936 suicides) over the next 10 years. In comparison, estimates from the dynamic simulation model which accounts for changes in the effect size of the intervention over time, the time taken for the intervention to have an impact in the population, and likely barriers to the uptake and availability of services suggest that the intervention would avert a lower proportion of suicides (between 0.4% and 0.5%) over the same follow-up period. Conclusion: Traditional epidemiological measures used to estimate population health burden have several limitations that are often understated and can lead to unrealistic expectations of the potential impact of evidence-based interventions in real-world settings. This study highlights these limitations and proposes an alternative analytic approach to guide policy and practice decisions to achieve reductions in Australian suicide.

scholarly journals Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007 - 2016

2020 ◽  
Author(s):  
Wayne Jones ◽  
Paul Kurdyak ◽  
Benedikt Fischer
Keyword(s):  
Disease Burden ◽  
Population Level ◽  
Hospitalization Rates ◽  
Defined Daily Doses ◽  
High Contribution ◽  
Stratified Sample ◽  
Hospital Morbidity ◽  
Strong Opioids ◽  
Dispensing Data ◽  
Related Mortality

Abstract Background: High levels of opioid-related mortality, as well as morbidity, contribute to the excessive opioid-related disease burden in North America, induced by high availability of opioids. While correlations between opioid dispensing levels and mortality outcomes are well-established, fewer evidence exists on correlations with morbidity (e.g., hospitalizations).Methods: We examined possible overtime correlations between medical opioid dispensing and opioid-related hospitalizations in Canada, by province, 2007 – 2016. For dispensing, we examined annual volumes of medical opioid dispensing from a representative, stratified sample of retail pharmacies across Canada. Raw dispensing information for ‘strong opioids’ was converted into Defined Daily Doses per 1,000 population per day (DDD/1,000/day). Opioid-related hospitalization rates referred to opioid poisoning-related admissions by province, for fiscal years 2007-08 to 2016-17, drawn from the national Hospital Morbidity Database. We assessed possible correlations between opioid dispensing and hospitalizations by province using the Pearson product moment correlation; correlation values (r) and confidence intervals were reported.Results: Significant correlations for overtime correlations between population-levels of opioid dispensing and opioid-related hospitalizations were observed for three provinces: Quebec (r=0.87, CI: 0.49–0.97; p=0.002); New Brunswick (r=0.85;CI: 0.43–0.97; p=0.004) and Nova Scotia (r=0.78; CI:0.25–0.95; p=0.012), with Saskatchewan (r=0.073; CI:-0.07–0.91;p=0.073) featuring borderline significance.Conclusions: The correlations observed further contribute to evidence on opioid dispensing levels as a systemic driver of population-level harms. Notably, correlations were not identified principally in provinces with reported high contribution levels (>50%) of illicit opioids to mortality, which are not captured by dispensing data and so may have distorted potential effects due to contamination.

scholarly journals Patterns, Changes, and Trends in Prescription Opioid Dispensing in Canada, 2005–2016

2018 ◽  
Vol 1 (21;1) ◽  
pp. 219-228 ◽  
Author(s):  
Benedikt Fischer
Keyword(s):  
Population Monitoring ◽  
Measurement Unit ◽  
Prescription Opioid ◽  
Global Comparison ◽  
Defined Daily Doses ◽  
Time Patterns ◽  
Break Points ◽  
Dispensing Data ◽  
Related Harm ◽  
Over Time

Background: Levels of prescription opioid (PO) dispensing have been rising in Canada – also in global comparison – since the mid-2000s, and are co-occurring with extensive POrelated morbidity and mortality. Previous analyses have demonstrated correlations between PO dispensing and related harm levels, yet also distinct heterogeneous interprovincial POdispensing patterns, in regards to quantities and individual PO formulations. Several systemlevel interventions have been implemented recently (since 2012) to address high PO-use levels and related harms in Canada; the effects of these interventions on PO-dispensing levels remain largely unexamined. Objectives: Our aim was to examine over-time patterns and trends of levels of PO dispensing quantitatively (in defined daily doses [DDDs]) for ‘strong’ and ‘weak’ opioids and qualitatively (by individual PO formulations) by province and Canada total, for the period of 2005–2016. Methods: We examined annual PO-dispensing levels, by ‘weak’ and ‘strong’ POs (individual PO formulations, but excluding methadone), by province and for Canada total, from 2005– 2016. Raw dispensing information for POs were obtained from IMSQuintiles CompuScript [new name: IQVIA], based on monthly retail dispensing data from a representative sample of community pharmacies covering about 80% of all dispensing episodes in Canada. These data were converted into annual dispensing values in DDDs (DDD/1,000 population/day), based on standard methodology, for the PO formulation groups of interest. Patterns and trends of ‘strong’ and ‘weak’ POs and individual PO formulations were examined descriptively, aided by segmented regression analyses to identify significant break-points in over-time trends. In addition, changes in ‘strong’/‘weak’ PO dispensing ratios between 2005 and 2016 were examined. Results: ‘Weak’ PO use remained largely stable across Canada over the study period. For ‘strong’ PO dispensing, half of the provinces featured consistent increases, while remaining provinces presented initial increases with subsequently reverting downward trends at divergent levels. Dispensing of individual ‘strong’ PO formulations varied interprovincially; specifically, substantial decreases for oxycodone co-occurred with increases in other ‘strong’ PO formulations. The dispensing ratios for ‘strong’/‘weak’ POs increased significantly across jurisdictions between 2005 and 2016 (P < .05). Limitations: Retail pharmacy-based data do not cover the total – but the large majority – of PO dispensing in Canada. There are limitations to DDD/1,000 population/day as a comparative measurement unit for PO dispensing. The causal contribution of interventions associated with changes in PO dispensing observed cannot be verified with the data available. Conclusions: Heterogeneous trends for PO dispensing, driven mostly by variations in ‘strong’ PO use, continue to be observed provincially across Canada. Recent changes in PO dispensing are likely influenced by recent intervention efforts (e.g., PO de-scheduling, monitoring, guidelines) aiming to reduce PO-related harms, which, however, have shown limited impact on PO-dispensing levels to date. Key words: Opioids, prescribing, dispensing, interventions, policy, population, monitoring, Canada

scholarly journals Prescription opioid dispensing in Canada: an update on recent developments to 2018

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Wayne Jones ◽  
Lenka Vojtila ◽  
Paul Kurdyak ◽  
Benedikt Fischer
Keyword(s):  
Control Measures ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Community Based ◽  
Defined Daily Doses ◽  
Sample Data ◽  
Recent Developments ◽  
Strong Opioids ◽  
Dispensing Data ◽  
Illicit Opioid Use

Abstract Canada has been home to comparatively extreme developments in prescription opioid (PO) availability and related harms (e.g. morbidity, mortality) post-2000. Following persistent pan-Canadian increases in PO use, select control measures were implemented and PO dispensing levels—while only inconsistently by province—inverted, and began to plateau or decrease post-2012. We examined annual PO dispensing levels in Canada up until 2018, based on representative prescription sample data from community-based retail pharmacies. Annual prescription-based dispensing data were converted into defined daily doses/1000 population/day by province, and mainly categorized into ‘weak’ and ‘strong’ opioids. All provinces indicated decreasing trends in strong PO levels in most recent years, yet with inter-provincial differences of up to one magnitude in 2018; in about half the provinces, dispensing fell to below-2005 levels. British Columbia had the largest decline in strong PO dispensing from its peak rate (− 48.5%) in 2011. Weak opioid dispensing trends remained more inconsistent and bifurcated across Canada. The distinct effects of individual—including many provincially initiated and governed—PO control measures urgently need to be evaluated. In the meantime, recent reductions in general PO availability across Canada appear to have contributed to shortages in opioid supply for existent, sizable (including non-medical) user populations and may have contributed to recent marked increases in illicit opioid use and harms (including rising deaths).

scholarly journals Opioid Consumption Trends in Spain: The Case of the Island of La Gomera (2016-2019)

2021 ◽  
Author(s):  
Alexis Oliva ◽  
Néstor Armas ◽  
Sandra Devora ◽  
Susan Abdala
Keyword(s):  
Classification System ◽  
Population Level ◽  
Consumption Patterns ◽  
Community Pharmacies ◽  
Sociodemographic Characteristics ◽  
Prescribing Habits ◽  
Defined Daily Doses ◽  
Opioid Drugs ◽  
Strong Opioids ◽  
La Gomera

Abstract This study aimed to describe the consumption of opioid drugs in the island of La Gomera over a four-year period (2016–2019) at various levels (island, township and health areas). Data were extracted from the wholesaler in community pharmacies at a population level. Consumption patterns were expressed as number of Defined Daily Doses per 1000 inhabitant /day (DID) and by the number of sold units per 1000 inhabitants and year. A common classification system (ATC) and the two units of measurement proposed enabled comparisons at various levels. Major differences between island, township, and health areas are presented. Little is known about the reasons for these differences. The opioids belonging to the N02AJ groups and N02AX were the most consumed according to the “sold units” parameter, which accounted for 69.48% and 18.59%, respectively. The situation was similar in terms of DID, although with lower percentages, but a significative increase was observed in the use of fentanyl and buprenorphine, around 15% each. The balance between the uses of weak or strong opioids showed differences in La Gomera compared to those nationwide. In mainland Spain, almost 70% of the consumption came from weak opioids versus that of 58.67% in La Gomera. Fentanyl was the most frequently used strong opioid (16.10%) followed by tapentadol and buprenorphine, around 5% each, whereas in La Gomera buprenorphine was the most consumed (15.75%) followed by fentanyl (14.87%) and tapentadol (5.82%). These differences in opioids consumption are most likely explained by different changes on the prescribing habits and sociodemographic characteristics.

scholarly journals Recomposing persons: Scavenging and storytelling in a birth cohort archive

2021 ◽  
pp. 095269512199539
Author(s):  
Penny Tinkler ◽  
Resto Cruz ◽  
Laura Fenton
Keyword(s):  
Life Course ◽  
Cohort Studies ◽  
Birth Cohort ◽  
Quantitative Data ◽  
Population Level ◽  
Relational Embeddedness ◽  
The Life Course ◽  
Over Time

Birth cohort studies can be used not only to generate population-level quantitative data, but also to recompose persons. The crux is how we understand data and persons. Recomposition entails scavenging for various (including unrecognised) data. It foregrounds the perspective and subjectivity of survey participants, but without forgetting the partiality and incompleteness of the accounts that it may generate. Although interested in the singularity of individuals, it attends to the historical and relational embeddedness of personhood. It examines the multiple and complex temporalities that suffuse people’s lives, hence departing from linear notions of the life course. It implies involvement, as well as reflexivity, on the part of researchers. It embraces the heterogeneity and transformations over time of scientific archives and the interpretive possibilities, as well as incompleteness, of birth cohort studies data. Interested in the unfolding of lives over time, it also shines light on meaningful biographical moments.

scholarly journals Evolution of immune responses to SARS-CoV-2 in mild-moderate COVID-19

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Adam K. Wheatley ◽  
Jennifer A. Juno ◽  
Jing J. Wang ◽  
Kevin J. Selva ◽  
Arnold Reynaldi ◽  
...  
Keyword(s):  
T Cell ◽  
B Cell ◽  
Vaccine Development ◽  
Natural Infection ◽  
Population Level ◽  
Cell Dynamics ◽  
Follicular Helper ◽  
Cell Immunity ◽  
Specific Igg ◽  
Over Time

AbstractThe durability of infection-induced SARS-CoV-2 immunity has major implications for reinfection and vaccine development. Here, we show a comprehensive profile of antibody, B cell and T cell dynamics over time in a cohort of patients who have recovered from mild-moderate COVID-19. Binding and neutralising antibody responses, together with individual serum clonotypes, decay over the first 4 months post-infection. A similar decline in Spike-specific CD4+ and circulating T follicular helper frequencies occurs. By contrast, S-specific IgG+ memory B cells consistently accumulate over time, eventually comprising a substantial fraction of circulating the memory B cell pool. Modelling of the concomitant immune kinetics predicts maintenance of serological neutralising activity above a titre of 1:40 in 50% of convalescent participants to 74 days, although there is probably additive protection from B cell and T cell immunity. This study indicates that SARS-CoV-2 immunity after infection might be transiently protective at a population level. Therefore, SARS-CoV-2 vaccines might require greater immunogenicity and durability than natural infection to drive long-term protection.

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