The rate of fatal overdoses from opioids such as oxycodone and morphine has soared over the last 20 years as prescriptions for the addictive and highly potent painkillers have continued to rise, an Ontario study has found.
The annual rate of opioid-related deaths jumped by 242 per cent between
1991 and 2010, said lead author Tara Gomes, a scientist at the Institute
for Clinical Evaluative Sciences, or ICES, which conducted the study
published Monday in the journal Addiction.
“In 2010, we found
that there were approximately 550 deaths related to opioid overdose,
which equates to one or two deaths every day,” said Gomes, noting that
the annual fatal overdose rate two decades earlier was 127.
The
highest proportion of deaths was clustered among young adults, say the
researchers, who analyzed provincial coroner's records from 1991 to
2010.
“One in every eight deaths in people aged 25 to 34 were
related to opioid overdoses,” said Gomes. Twenty years ago, the rate for
that age group was one in 25.
“Given the concentration of deaths
in the younger ages, we found that opioid-related deaths had a
considerable societal burden,” she said. “In 2010, these deaths led to
over 20,000 years of life lost.”
In all, 5,935 Ontarians died from opioid overdoses in the 20-year period.
“These
could be people who purchased the drugs on the street, these could be
people who received legitimate prescriptions and mistakenly took too
much of the drug or escalated their dose without checking with their
primary-care provider,” Gomes speculated.
“These could also be
people who have heard about recreational use of these drugs and knew to
go into their parents' or grandparents' medicine cabinet and find the
drug and try it. And never having taken the drug before, they can
overdose after just one or two pills of a high-strength formulation.”
Over
the last two decades, several new products have come on the market,
among them oxycodone. Doctors began prescribing the drugs more often to
treat those with intractable pain, and often in increasingly potent
doses.
“And I think the combination of these factors is likely
driving a lot of this increased risk of opioid overdose that we're
seeing, because there's a lot more of the products available, and as
well these drugs are being used at higher doses,” she said.
“And we have seen in past research that higher doses of opioids are associated with increased risk of overdose death.”
Codeine, hydromorphone, morphine, fentanyl and oxycodone are the “big players” among the opioids, she said.
Opioid
prescription rates have continued to rise, driven by aggressive
marketing by manufacturers of the products to physicians, who she
believes have become more comfortable with recommending them for
patients suffering with hard-to-treat pain.
But drug-seeking
behaviour by those looking to abuse the medications is also likely
driving up prescribing rates, she said, adding that opioids' addictive
nature can lead to someone visiting several doctors to obtain multiple
prescriptions, a phenomenon known as double-doctoring.
Gomes suspects the escalation in opioid overdose deaths is likely occurring across the country.
However,
there is no national database to track overdose deaths, said Benedikt
Fischer, a professor of health sciences at Simon Fraser University in
Burnaby, B.C., although the numbers are moving upwards in that province
as well.
“It's an extremely worrisome picture that the number of
deaths are going up and have been going up for many years the way they
are,” Fischer, who was not involved in the study, said of the Ontario
findings. “And this is a huge death toll.
“We know that the
number of opioid deaths is almost perfectly correlated to the amount of
prescription opioids dispensed to the population. So, in essence, the
number of deaths are a function of the amount of opioids prescribed and
dispensed into the population.”
In order to reduce the death toll
from prescription opioids, a strategy needs to be formulated to reduce
the amounts being dispensed, he said, noting that Canadians are the
second-largest per capita users of these drugs in the world after
Americans.
Fischer said that while chopping the overdose death
toll has to begin with doctors cutting back on prescriptions, it's also
critical to recognize that these medications play a key role in treating
many patients with pain, including those with cancer.
“Let me be
clear. We cannot afford to eliminate these medications. We need them,”
he said. “They're important to a lot of people with chronic and severe
pain who need these drugs.
“But current prescribing and dispensing goes far beyond those parameters. It exceeds those hazardously.”
The Ontario researchers have developed an interactive map of Ontario counties with the highest rates of opioid overdose deaths, including Thunder Bay and Sudbury, and large urban centres like Toronto.
Gomes
said health-care providers need to ensure that patients understand the
risks opioids may pose and that they should be “very careful” with their
use.
“They shouldn't share their drugs, they shouldn't escalate
their dose without consulting their physician and they should just be
very aware that these are risky drugs that can be effective but can also
be very dangerous.”
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