Emilie J. Gladstone

Geographic Variations in Prescription Opioid Dispensations and Deaths Among Women and Men in British Columbia, Canada.

Objectives: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. Conclusion:Targeted efforts to reduce high levels of opioid prescribing in BC, particularly dispensations of strong opioids and codeine, may substantially reduce opioid-related harms.

Sensitivity and specificity of administrative mortality data for identifying prescription opioid–related deaths

Background: Comprehensive systems for surveilling prescription opioid–related harms provide clear evidence that deaths from prescription opioids have increased dramatically in the United States. However, these harms are not systematically monitored in Canada. In light of a growing public health crisis, accessible, nationwide data sources to examine prescription opioid–related harms in Canada are needed. We sought to examine the performance of 5 algorithms to identify prescription opioid–related deaths from vital statistics data against data abstracted from the Office of the Chief Coroner of Ontario as a gold standard. Methods: We identified all prescription opioid–related deaths from Ontario coroners’ data that occurred between Jan. 31, 2003, and Dec. 31, 2010. We then used 5 different algorithms to identify prescription opioid–related deaths from vital statistics death data in 2010. We selected the algorithm with the highest sensitivity and a positive predictive value of more than 80% as the optimal algorithm for identifying prescription opioid–related deaths. Results: Four of the 5 algorithms had positive predictive values of more than 80%. The algorithm with the highest sensitivity (75%) in 2010 improved slightly in its predictive performance from 2003 to 2010. Interpretation: In the absence of specific systems for monitoring prescription opioid–related deaths in Canada, readily available national vital statistics data can be used to study prescription opioid–related mortality with considerable accuracy. Despite some limitations, these data may facilitate the implementation of national surveillance and monitoring strategies.

Long-term sedative use among community-dwelling adults: a population-based analysis

BACKGROUND Chronic use of benzodiazepines and benzodiazepine-like sedatives (z-drugs) presents substantial risks to people of all ages. We sought to assess trends in long-term sedative use among community-dwelling adults in British Columbia. METHODS Using population-based linked administrative databases, we examined longitudinal trends in age-standardized rates of sedative use among different age groups of community-dwelling adults (age ≥ 18 yr), from 2004 to 2013. For each calendar year, we classified adults as nonusers, short-term users, or long-term users of sedatives based on their patterns of sedative dispensation. For calendar year 2013, we applied cross-sectional analysis and estimated logistic regression models to identify health and socioeconomic risk factors associated with long-term sedative use. RESULTS More than half (53.4%) of long-term users of sedatives in British Columbia are between ages 18 and 64 years (young and middle-aged adults). From 2004 to 2013, long-term sedative use remained stable among adults more than 65 years of age (older adults) and increased slightly among young and middle-aged adults. Although the use of benzodiazepines decreased during the study period, the trend was offset by equal or greater increases in long-term use of z-drugs. Being an older adult, sick, poor and single were associated with increased odds of long-term sedative use. INTERPRETATION Despite efforts to stem such patterns of medication use, long-term use of sedatives increased in British Columbia between 2004 and 2013. This increase was driven largely by increased use among middle-aged adults. Future deprescribing efforts that target adults of all ages may help curb this trend.

Determinants of trends in prescription opioid use in British Columbia, Canada, 2005-2013.

To explore the determinants of total opioid consumption in a Canadian province, and to examine patterns of opioid dispensations by sex, age, and income quintile.

Trends and sex differences in prescription opioid deaths in British Columbia, Canada

Increasing rates of prescription opioid-related death are well documented in Ontario (ON) but little is known about prescription opioid-related harms in other Canadian provinces. Using administrative mortality data from 2004 to 2013, we found that rates of prescription opioid-related death in British Columbia (BC) were higher but more stable than published rates for ON over the same period. Methadone was involved in approximately 25% of the prescription opioid-related deaths in BC. The majority of prescription opioid-related deaths among men and women were unintentional. Men had higher overall rates of prescription opioid-related deaths in BC; women had lower rates of prescription opioid-related deaths but a larger proportion of them were suicides. Efforts to reduce prescription opioid-related deaths must consider sex differences in patterns of prescription opioid use and associated harms.

High-Cost Users of Prescription Drugs: A Population-Based Analysis from British Columbia, Canada

Objective To examine variation in pharmaceutical spending and patient characteristics across prescription drug user groups. Data Sources British Columbias population‐based linked administrative health and sociodemographic databases (N = 3,460,763). Study Design We classified individuals into empirically derived prescription drug user groups based on pharmaceutical spending patterns outside hospitals from 2007 to 2011. We examined variation in patient characteristics, mortality, and health services usage and applied hierarchical clustering to determine patterns of concurrent drug use identifying high‐cost patients. Principal Findings Approximately 1 in 20 British Columbians had persistently high prescription costs for 5 consecutive years, accounting for 42 percent of 2011 province‐wide pharmaceutical spending. Less than 1 percent of the population experienced discrete episodes of high prescription costs; an additional 2.8 percent transitioned to or from high‐cost episodes of unknown duration. Persistent high‐cost users were more likely to concurrently use multiple chronic medications; episodic and transitory users spent more on specialized medicines, including outpatient cancer drugs. Cluster analyses revealed heterogeneity in concurrent medicine use within high‐cost groups. Conclusions Whether low, moderate, or high, costs of prescription drugs for most individuals are persistent over time. Policies controlling high‐cost use should focus on reducing polypharmacy and encouraging price competition in drug classes used by ordinary and high‐cost users alike.

Benchmarking prescription drug access patterns in pharmaceutical claims: a method for identifying high and potentially harmful opioid use in Australia and Canada?

We use dispensing claims to benchmark prescriber access patterns for opioids against statins (a drug class with no known abuse potential) in Australia and British Columbia, Canada.