title: Non-medical prescription opioid use, prescription opioid-related harms and public health in Canada: an update 5 years later.
abstract: Five years ago, we highlighted Canada's emerging problem of prescription opioid (PO)-related harms and emphasized the need for targeted surveillance, research and interventions. Overall levels of PO use in the Canadian population have grown by 70% since then, while at the same time levels of non-medical PO use (NMPOU) in general and in key risk populations have continued to be high; furthermore, PO-related harms - specifically morbidity (e.g., treatment admissions) and mortality (e.g., overdose deaths) - have risen substantively. Unfortunately, major knowledge gaps related to systematic monitoring of PO-related harms continue to exist; for example, no national morbidity or mortality statistics are available. Investigator-driven research has generated important insights into the epidemiology and impacts of PO-related harms: high correlations between population-level PO dispensing and/or PO dosing and harms; high rates of co-occurrence of NMPOU and co-morbidities; and distinct NMPOU-related risk dynamics among street drug users. Select policy measures have been implemented only recently at the federal and provincial levels; these interventions remain to be systematically evaluated, especially given preliminary indications of reductions in PO-related harms (e.g., NMPOU) unfolding prior to the interventions. For these purposes, improvements in surveillance tools and research resources devoted to the extensive public health problem of PO-related harms in Canada continue to be urgently needed.
authors.affiliation: Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver; Social and Epidemiological Research, Centre for Addiction and Mental Health (CAMH), Toronto; Department of Psychiatry, University of Toronto. bfischer@sfu.ca.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Fischer
authors.forename: Jenna
authors.initials: J
authors.lastname: Gooch
authors.forename: Brian
authors.initials: B
authors.lastname: Goldman
authors.forename: Paul
authors.initials: P
authors.lastname: Kurdyak
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D011634:Public Health
chemical_list: D000701:Analgesics, Opioid
keywords: Canada; Prescription opioids; harms; non-medical use; policy; public health; surveillance