ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2009
Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01934751 (Randomized Controlled Trial on the Effectiveness of Immediate Versus Delayed Access to Hospital-based Addiction Services), which is not on this map. Cited by 191 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomized Controlled Trial on the Effectiveness of Immediate Versus Delayed Access to Hospital-based Addiction Services
Who cites it
191 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Oxycodone for neuropathic pain in adults.The Cochrane database of systematic reviews · 2016Pooled it
- Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review.American journal of public health · 2014Pooled it
- Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population.Canadian family physician Medecin de famille canadien · 2011Guideline
- Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 2: special populations.Canadian family physician Medecin de famille canadien · 2011Guideline
- Trial
- Effectiveness of Oxycodone Hydrochloride (Strong Opioid) vs Combination Acetaminophen and Codeine (Mild Opioid) for Subacute Pain After Fractures Managed Surgically: A Randomized Clinical Trial.JAMA network open · 2021Trial
- Buprenorphine in the emergency department: Randomized clinical controlled trial of clonidine versus buprenorphine for the treatment of opioid withdrawal.Canadian family physician Medecin de famille canadien · 2019Trial
- The effects of pioglitazone, a PPARγ receptor agonist, on the abuse liability of oxycodone among nondependent opioid users.Physiology & behavior · 2016Trial
- Patients as collaborators: using focus groups and feedback sessions to develop an interactive, web-based self-management intervention for chronic pain.Pain medicine (Malden, Mass.) · 2013Trial
- Adverse selection? A multi-dimensional profile of people dispensed opioid analgesics for persistent non-cancer pain.PloS one · 2013Trial
- Miconazole oral gel increases exposure to oral oxycodone by inhibition of CYP2D6 and CYP3A4.Antimicrobial agents and chemotherapy · 2011Trial
- A Survey of Knowledge, Attitudes, and Behaviours of Canadian Family Physicians in Response to the Canadian Guideline on Prescribing Opioids for Chronic Non-cancer Pain.Canadian journal of pain = Revue canadienne de la douleur · 2026Article
- Trends in prescription opioid use for pain in Canada: a population-based repeated cross-sectional study of 6 provinces.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025Article
- Evaluation of physicians' opioid prescribing practices, attitudes, and interactions with other healthcare professionals in optimizing opioid prescribing in Pakistan.Frontiers in pharmacology · 2025Article
- Association of postoperative opioid type with mortality and readmission rates: multicentre retrospective cohort study.BJS open · 2024Article
- Exploring Opioid Prescription Patterns and Overdose Rates in South Carolina (2017-2021): Insights into Rising Deaths in High-Risk Areas.Healthcare (Basel, Switzerland) · 2024Article
- Ethical Challenges of Virtual Reality Technology Interventions for the Vulnerabilities of Patients With Chronic Pain: Exploration of Technician Responsibility.Journal of medical Internet research · 2023Article
- The effects of (2R,6R)-hydroxynorketamine on oxycodone withdrawal and reinstatement.Drug and alcohol dependence · 2023Article
- Prescription of oxycodone versus codeine after childbirth and risk of persistent opioid use: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
- Article
131 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
Authors and funding
6 authors.
Funding
Abstract
introductionOpioid-related mortality appears to be increasing in Canada. We examined the true extent of the problem and the impact of the introduction of long-acting oxycodone.
methodsWe examined trends in the prescribing of opioid analgesics in the province of Ontario from 1991 to 2007. We reviewed all deaths related to opioid use between 1991 and 2004. We linked 3271 of these deaths to administrative data to examine the patients' use of health care services before death. Using time-series analysis, we determined whether the addition of long-acting oxycodone to the provincial drug formulary in January 2000 was associated with an increase in opioid-related mortality.
resultsFrom 1991 to 2007, annual prescriptions for opioids increased from 458 to 591 per 1000 individuals. Opioid-related deaths doubled, from 13.7 per million in 1991 to 27.2 per million in 2004. Prescriptions of oxycodone increased by 850% between 1991 and 2007. The addition of long-acting oxycodone to the drug formulary was associated with a 5-fold increase in oxycodone-related mortality (p<0.01) and a 41% increase in overall opioid-related mortality (p=0.02). The manner of death was deemed unintentional by the coroner in 54.2% and undetermined in 21.9% of cases. Use of health care services in the month before death was common: for example, of the 3066 patients for whom data on physician visits were available, 66.4% had visited a physician in the month before death; of the 1095 patients for whom individual-level prescribing data were available, 56.1% had filled a prescription for an opioid in the month before death.
interpretationOpioid-related deaths in Ontario have increased markedly since 1991. A significant portion of the increase was associated with the addition of long-acting oxycodone to the provincial drug formulary. Most of the deaths were deemed unintentional. The frequency of visits to a physician and prescriptions for opioids in the month before death suggests a missed opportunity for prevention.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.