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Correlations between Changes in Medical Opioid Dispensing and Contributions of Fentanyl to Opioid-Related Overdose Fatalities: Exploratory Analyses from Canada

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Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC V6B 5K3, Canada
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Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
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Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
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Department of Psychiatry, Federal University of São Paulo (UNIFESP), R. Sena Madureira, 1500-Vila Clementino, São Paulo 04017-030, Brazil
*
Author to whom correspondence should be addressed.
Academic Editor: Icro Maremmani
Int. J. Environ. Res. Public Health 2021, 18(14), 7507; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147507
Received: 24 June 2021 / Revised: 9 July 2021 / Accepted: 12 July 2021 / Published: 14 July 2021
Canada is experiencing an epidemic of opioid-related mortality, with increasing yet heterogeneous fatality patterns from illicit/synthetic (e.g., fentanyl) opioids. The present study examined whether differential provincial reductions in medical opioid dispensing following restrictive regulations (post-2010) were associated with differential contributions of fentanyl to opioid mortality. Annual provincial opioid dispensing totals in defined daily doses/1000 population/day, and change rates in opioid dispensing for the 10 provinces for (1) 2011–2018 and (2) “peak-year” to 2018 were derived from a pan-Canadian pharmacy-based dispensing panel. Provincial contribution rates of fentanyl to opioid-related mortality (2016–2019) were averaged. Correlation values (Pearson’s R) between provincial changes in opioid dispensing and the relative fentanyl contributions to mortality were computed for the two scenarios. The correlation between province-based changes in opioid dispensing (2011–2018) and the relative contribution of fentanyl to total opioid deaths (2016–2019) was −0.70 (t = 2.75; df = 8; p = 0.03); the corresponding correlation for opioid dispensing changes (“peak-year” to 2018) was −0.59 (t = −2.06; df = 8; p = 0.07). Provincial reductions in medical opioid dispensing indicated (near-)significant correlations with fentanyl contribution rates to opioid-related death totals. Differential reductions in pharmaceutical opioid availability may have created supply voids for nonmedical use, substituted with synthetic/toxic (e.g., fentanyl) opioids and leading to accelerated opioid mortality. Implications of these possible unintended adverse consequences warrant consideration for public health policy. View Full-Text
Keywords: prescription opioids; mortality; synthetic opioids; nonmedical use; supply; substitution; public health; Canada prescription opioids; mortality; synthetic opioids; nonmedical use; supply; substitution; public health; Canada
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MDPI and ACS Style

Jones, W.; Lee, M.-H.; Kaoser, R.; Fischer, B. Correlations between Changes in Medical Opioid Dispensing and Contributions of Fentanyl to Opioid-Related Overdose Fatalities: Exploratory Analyses from Canada. Int. J. Environ. Res. Public Health 2021, 18, 7507. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147507

AMA Style

Jones W, Lee M-H, Kaoser R, Fischer B. Correlations between Changes in Medical Opioid Dispensing and Contributions of Fentanyl to Opioid-Related Overdose Fatalities: Exploratory Analyses from Canada. International Journal of Environmental Research and Public Health. 2021; 18(14):7507. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147507

Chicago/Turabian Style

Jones, Wayne, Min-Hye Lee, Ridhwana Kaoser, and Benedikt Fischer. 2021. "Correlations between Changes in Medical Opioid Dispensing and Contributions of Fentanyl to Opioid-Related Overdose Fatalities: Exploratory Analyses from Canada" International Journal of Environmental Research and Public Health 18, no. 14: 7507. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147507

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