title: Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review.
abstract: We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013. We identified 17 determinants of opioid-related mortality and mortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult. Preventing additional opioid-related mortality will likely require interventions that address multiple determinants and are tailored to specific locations and populations.
authors.affiliation: Nicholas B. King is with the Biomedical Ethics Unit and the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec. Veronique Fraser is with the Biomedical Ethics Unit, McGill University. Constantina Boikos, Robin Richardson, and Sam Harper are with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University.
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: King
authors.forename: Veronique
authors.initials: V
authors.lastname: Fraser
authors.forename: Constantina
authors.initials: C
authors.lastname: Boikos
authors.forename: Robin
authors.initials: R
authors.lastname: Richardson
authors.forename: Sam
authors.initials: S
authors.lastname: Harper
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009665:Noscapine; D009293:Opioid-Related Disorders / Q000401:mortality* / Q000523:psychology; D010098:Oxycodone / Q000009:adverse effects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D009665:Noscapine; D010098:Oxycodone; D008691:Methadone