title: Geographic Variations in Prescription Opioid Dispensations and Deaths Among Women and Men in British Columbia, Canada.
abstract: OBJECTIVE
  We quantify patterns in prescription opioid dispensations to individuals who suffered a prescription opioid-related death. In addition, we examine the relationship between opioid dispensations and prescription opioid-related deaths in geographic regions of British Columbia (BC).
  
  
  METHODS
  We used population-based administrative data on prescription drug dispensations to identify patterns in prescription opioid dispensations to individuals who suffered a prescription opioid-related death. We also computed the quantity of prescription opioids dispensed (morphine equivalents) in small geographic regions in BC from 2004 to 2013. We identified prescription opioid-related deaths in these small geographic areas using mortality data from BC Vital Statistics and investigated the relationship between rates of prescription opioid dispensing and rates of prescription opioid death in small geographic areas in BC by sex. We examined differences in our results when limiting opioid dispensations to strong opioids and weak opioids.
  
  
  RESULTS
  Many individuals who suffered a prescription opioid-related death did not have an active opioid prescription in the 60 days before death (46% of women and 71% of men). Rates of prescription opioid dispensing and opioid-related deaths vary substantially across geographic regions in BC. The area-level relationship between rate of prescription opioid dispensing and rate of unintentional prescription opioid-related death is positive and statistically significant for both men and women (P<0.001). This relationship holds when opioid prescribing is limited to strong opioids.
  
  
  CONCLUSIONS
  Targeted efforts to reduce high levels of opioid prescribing in BC, particularly dispensations of strong opioids and codeine, may substantially reduce opioid-related harms.
authors.affiliation: *School of Population and Public Health †Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Emilie J
authors.initials: EJ
authors.lastname: Gladstone
authors.forename: Kate
authors.initials: K
authors.lastname: Smolina
authors.forename: Deirdre
authors.initials: D
authors.lastname: Weymann
authors.forename: Kimberly
authors.initials: K
authors.lastname: Rutherford
authors.forename: Steven G
authors.initials: SG
authors.lastname: Morgan
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000506:poisoning*; D001955:British Columbia; D062787:Drug Overdose / Q000401:mortality*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000401:mortality*; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D063487:Prescription Drug Misuse / Q000401:mortality*; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000701:Analgesics, Opioid