Abstract
Objective
Medical prescriptions for opioids as well as their non-medical use have increased in Canada in recent years. This study aimed to estimate the number of non-medical prescription opioid (PO) users in the general and street drug using populations in Canada.
Methods
The number of non-medical PO users among the general population and the number of non-medical PO users, heroin users, or both among the street drug using population was estimated for Canada and for the most populous Canadian provinces. Different estimation methods were used: 1) the number of non-medical PO users in the Canadian general population was estimated based on Canadian availability data, and the ratio of US availability to non-medical PO use from US survey data; 2) numbers within the street drug using population were indirectly estimated based on overdose death data, and a key informants survey. Distribution and trends by usage of opioids were determined by using the multi-site Canadian OPICAN cohort data.
Results
Between 321,000 to 914,000 non-medical PO users were estimated to exist among the general population in Canada in 2003. The estimated number of non-medical PO users, heroin users, or both among the street drug using population was about 72,000, with more individuals using nonmedical PO than heroin in 2003. Based on data from the OPICAN survey, in 2005 the majority of the street drug using population in main Canadian cities was non-medical PO users, with the exception of Vancouver and Montreal. A relative increase of 24% was observed from 2002 to 2005 in the proportion of the street drug using population who used non-medical POs only.
Discussion
There is an urgent need to further assess the extent and patterns of non-medical prescription opioid use, related problems and drug distribution channels in Canada.
Key words: Analgesics, prescription, opioid, abuse, Canada
Résumé
Objectif
Les prescriptions médicales pour les opiacés ainsi que leur utilisation non médicinale ont augmenté au Canada au cours des dernières années. Cette étude vise à évaluer le nombre d’utilisateurs d’opiacés d’ordonnance (OO) non médicinaux au sein de la population générale et de la population utilisant des drogues illicites au Canada.
Méthode
Le nombre d’utilisateurs d’OO non médicinaux parmi la population générale et le nombre d’utilisateurs d’OO non médicinaux, d’utilisateurs d’héroïne ou les deux parmi la population faisant usage de drogues illicites ont été évalués au Canada et dans les provinces canadiennes les plus populeuses. Différentes méthodes d’évaluation ont été utilisées: 1) le nombre d’utilisateurs d’OO non médicinaux au sein de la population générale du Canada a été évalué selon les données sur la disponibilité canadienne et le ratio de la disponibilité américaine pour l’utilisation d’OO non médicinaux à partir des données des études américaines; 2) le nombre au sein de la population faisant usage de drogues illicites était indirectement évalué selon les données sur le décès par surdose et une étude auprès de répondants clés. La distribution et les tendances selon l’usage d’opiacés ont été déterminées à l’aide des données de cohorte de l’étude OPICAN effectuée dans plusieurs villes canadiennes.
Résultats
On a évalué qu’il y avait entre 321 000 et 914 000 utilisateurs d’OO non médicinaux au sein de la population canadienne en 2003. Le nombre évalué d’utilisateurs d’OO non médicinaux, d’utilisateurs d’héroïne ou les deux parmi la population faisant usage de drogues illicites était de 72 000, avec davantage de personnes utilisant des OO non médicinaux que l’héroïne en 2003. Selon les données de l’étude OPICAN, en 2005, la majorité de la population faisant usage de drogues illicites dans les principales villes canadiennes était des utilisateurs d’OO non médicinaux, à l’exception de Montréal et de Vancouver. Un accroissement relatif de 24 % a été observé de 2002 à 2005 selon la proportion de la population faisant usage de drogues illicites qui utilisait des OO non médicinaux seulement.
Discussion
Il existe un besoin urgent d’évaluer davantage la portée et les modèles de l’utilisation d’OO non médicinaux, les problèmes connexes et les réseaux de distribution de drogues au Canada.
Mots clés: analgésiques, ordonnance, opiacé, abus, Canada
Footnotes
Acknowledgements: This study was supported in part by funding from the Canadian Institutes of Health Research. This contribution was also based on research within the framework of the Second Canadian Study on Social Costs of Substance Abuse, which has received funding from the Canadian Centre on Substance Abuse. In addition, the current study was also in part financially supported by a contract of Schering-Plough Canada to the Centre for Addiction and Mental Health. The authors would also like to thank Sandy Maksimowska and Dolly Baliunas for their thorough review of an earlier version of this manuscrip.
References
- 1.Fischer B, Rehm J, Patra J, Firestone-Cruz M. Changes in illicit opioid use across Canada. CMAJ. 2006;175(11):1385–87. doi: 10.1503/cmaj.060729. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Becker WC, Sullivan LE, Tetrault JM, Desai RA, Fiellin DA. Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates. Drug Alcohol Depend. 2008;94(1-3):38–47. doi: 10.1016/j.drugalcdep.2007.09.018. [DOI] [PubMed] [Google Scholar]
- 3.Compton W, Volkow N. Major increases in opioid analgesic abuse in the United States: Concerns and strategies. Drug Alcohol Depend. 2006;81:103–7. doi: 10.1016/j.drugalcdep.2005.05.009. [DOI] [PubMed] [Google Scholar]
- 4.Novak S, Nemeth WC, Lawson KA. Trends in medical use and abuse of sustained-release opioid analgesics: A revisit. Pain Med. 2004;5(1):59–65. doi: 10.1111/j.1526-4637.2004.04001.x. [DOI] [PubMed] [Google Scholar]
- 5.Zancy J, Bigelow G, Compton P, Foley K, Iguchi M, Sannerud C. College on problems of drug dependence taskforce on prescription opioid non-medical use and abuse: Position statement. Drug Alcohol Depend. 2003;69:215–32. doi: 10.1016/S0376-8716(03)00003-6. [DOI] [PubMed] [Google Scholar]
- 6.International Narcotics Control Board INCB. Report of the International Narcotics Control Board for 2005. Austria: Vienna; 2006. [Google Scholar]
- 7.Compton WM, Volkow ND. Abuse of prescription drugs and the risk of addiction. Drug Alcohol Depend. 2006;83(Suppl1):S4–S7. doi: 10.1016/j.drugalcdep.2005.10.020. [DOI] [PubMed] [Google Scholar]
- 8.Haydon E, Rehm J, Fischer B, Monga N, Adlaf E. Prescription drug abuse in Canada and the diversion of prescription drugs into the illicit drug market. Can J Public Health. 2005;96(6):459–61. doi: 10.1007/BF03405190. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Manchikanti L. Prescription drug abuse: What is being done to address this new drug epidemic? Pain Physician. 2006;9:287–321. [PubMed] [Google Scholar]
- 10.Martin TL, Woodall KL, McLellan BA. Fentanyl-related deaths in Ontario, Canada: Toxicological findings and circumstances of death in 112 cases (2002-2004) J Anal Toxicol. 2006;30:603–10. doi: 10.1093/jat/30.8.603. [DOI] [PubMed] [Google Scholar]
- 11.Paulozzi L, Budnitz D, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf. 2006;15(9):618–27. doi: 10.1002/pds.1276. [DOI] [PubMed] [Google Scholar]
- 12.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Primary Care. Washington, DC: American Psychiatric Association; 2000. [Google Scholar]
- 13.SAMHSA. Prevalence and recent trends in misuse of prescription drugs. U.S. Department of Health and Human Services, SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004. 2006. [Google Scholar]
- 14.ONDCP. Policy paper: Opioid agonist treatment. Washington, DC: Office of National Drug Control Policy (ONDCP); 1999. [Google Scholar]
- 15.Rubinkam M. Washington Post. 2005. Heroin addicts clamor for scarce medicine. [Google Scholar]
- 16.NIDA. Research report series, National Institute on Drug Abuse. Baltimore, MD: NIDA; 2005. [Google Scholar]
- 17.International Narcotics Control Board. Report of the International Narcotics Control Board for 2005. Austria: Vienna; 2005. [Google Scholar]
- 18.Popova S, Rehm J, Fischer B. An overview of illegal opioid use and health services utilization in Canada. Public Health. 2006;120(4):320–28. doi: 10.1016/j.puhe.2005.09.010. [DOI] [PubMed] [Google Scholar]
- 19.Fischer B, Rehm J. The case for a heroin substitution treatment trial in Canada. Can J Public Health. 1997;88:367–70. doi: 10.1007/BF03403907. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Rehm J. Modes de consommation et répartition des drogues en Suisse. In: Fahrenkrug H, Rehm J, Müller R, editors. Drogues illégales en Suisse 1990–1993. La situation dans les cantons et en Suisse. Zürich: Seismo; 1995. pp. 13–34. [Google Scholar]
- 21.WHO. The World Health Report 2002: Reducing risks, promoting healthy life. Geneva: WHO; 2002. [DOI] [PubMed] [Google Scholar]
- 22.Single E, Rehm J, Robson L, Van Truong M. The relative risks and aetiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada. CMAJ. 2000;162(12):1669–75. [PMC free article] [PubMed] [Google Scholar]
- 23.Rehm J, Baliunas D, Brochu S, Fischer B, Gnam W, Patra J, et al. The costs of substance abuse in Canada 2002. Ottawa, ON: Canadian Centre on Substance Abuse; 2006. [Google Scholar]
- 24.Fischer B, Rehm J, Brissette S, Brochu S, Bruneau J, El-Guebaly N, et al. Illicit opioid use in Canada: Comparing social, health and drug use characteristics of untreated users in five cities (OPICAN study) J Urban Health. 2005;82(2):250–66. doi: 10.1093/jurban/jti049. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Fischer B, Manzoni P, Rehm J. Comparing injecting and non-injecting illicit opioid users in a multi-site Canadian sample (OPICAN cohort) Eur Addict Res. 2006;12(4):230–39. doi: 10.1159/000094425. [DOI] [PubMed] [Google Scholar]
- 26.Bonin J, Fournier L, Blais R, Perreault M, White N. Are the responses of clients with psychiatric and addiction disorders using services for the homeless valid? Can J Psychiatry. 2007;52(12):798–802. doi: 10.1177/070674370705201207. [DOI] [PubMed] [Google Scholar]
- 27.Darke S. Self-report among injecting drug users: A review. Drug Alcohol Depend. 1998;51:253–63. doi: 10.1016/S0376-8716(98)00028-3. [DOI] [PubMed] [Google Scholar]
- 28.Gilchrist VJ. Key informant interviews. In: Crabtree BF, Miller WL, editors. Doing Qualitative Research. Thousand Oaks, CA: Sage Publications; 1992. [Google Scholar]
- 29.Marshall MN. The key informant technique. Family Practice. 1996;13:92–97. doi: 10.1093/fampra/13.1.92. [DOI] [PubMed] [Google Scholar]