ArticleBMJ (Clinical research ed.)2018
Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada.
Article in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 4 of them syntheses that pooled it.
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Who cites it
87 citing papers in PubMed, 4 syntheses or guidelines pooled it, 164 citations in OpenAlex.
- Preoperative Nonopioid Analgesia Reduces Postoperative Opioid Consumption After Arthroscopic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.The American journal of sports medicine · 2026Pooled it
- Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Pooled it
- Multidisciplinary care for opioid dose reduction in patients with chronic non-cancer pain: A systematic realist review.PloS one · 2020Pooled it
- Managing opioid use disorder in primary care: PEER simplified guideline.Canadian family physician Medecin de famille canadien · 2019Guideline
- Trial
- Opioid-specific risk of respiratory depression in non-cancer pain: a retrospective cohort study.BMC medicine · 2026Article
- Article
- Impact of the COVID-19 pandemic on opioid toxicity mortality rates in Nova Scotia: An interrupted time series analysis (2009-2023).Canadian journal of public health = Revue canadienne de sante publique · 2026Article
- Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis.Pain reports · 2026Review
- Prevalence of prescribed opioid claims among persons with non-traumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study.Spinal cord · 2026Article
- Burden of disease attributable to tobacco, high alcohol use, and drug use from 1990 to 2021.Frontiers in nutrition · 2026Article
- Opioid dispensing prior to opioid toxicity hospitalizations and emergency department visits in Canada, 2018-2022.PloS one · 2026Article
- Ten Years of ECHO Chronic Pain and Opioid Stewardship in Ontario: Impact and Future Directions.Healthcare (Basel, Switzerland) · 2025Article
- Substances and substance combinations among accidental substance-related acute toxicity deaths (AATDs) in Canada from 2016 to 2017.BMC public health · 2025Article
- Concurrent Prescribing of Opioids and Sedative-Hypnotic Drugs for Long-Term Use in Australian General Practice: A Cross-Sectional Analysis Using MedicineInsight.Pharmacology research & perspectives · 2025Article
- Trends in prescription opioid use in Europe: A DARWIN EUFrontiers in pharmacology · 2025Article
- Association Between Opioid-Related Mortality and History of Surgical Procedure: A Population-Based Case-Control Study.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- Severe Neonatal Opioid Withdrawal Requiring Pharmacotherapy: Impact of Region of Residence.American journal of perinatology · 2024Article
- Observational
- Accidental substance-related acute toxicity deaths in older adults in 2016 and 2017: a national chart review study.Health promotion and chronic disease prevention in Canada : research, policy and practice · 2024Article
27 more citing papers are in PubMed but not listed here.
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveTo describe the contributions of prescribed and non-prescribed opioids to opioid related deaths.
designPopulation based cohort study.
settingOntario, Canada, from 1 January 2013 to 31 December 2016.
participantsAll Ontarians who died of an opioid related cause. EXPOSURE: Active opioid prescriptions, defined as those with a duration overlapping the date of death, and recent opioid prescriptions, defined as those dispensed in the 30 and 180 days preceding death. Postmortem toxicology results from the Drug and Drug/Alcohol Related Death database were used to characterise deaths on the basis of presence of prescribed and non-prescribed (that is, diverted or illicit) opioids, overall and stratified by year and age.
results2833 opioid related deaths occurred. An active opioid prescription on the date of death was relatively common but declined slightly throughout the study period (38.2% (241/631) in 2013 and 32.5% (278/855) in 2016; P for trend=0.03). Older people and women were relatively more likely to have an active opioid prescription at time of death. In 2016, 46% (169/364) of people aged 45-64 had an active opioid prescription compared with only 12% (8/69) among those aged 24 or younger (P for trend<0.001). Similarly, 46% (124/272) of women had an active opioid prescription at time of death compared with 26.4% (154/583) of men (P<0.001). Among people with active opioid prescriptions at time of death, 37.8% (375/993) also had evidence of a non-prescribed opioid on postmortem toxicology. By 2016, the non-prescribed opioid most commonly identified after death was fentanyl (41%; 47 of 115 cases). Among people without an active opioid prescription at time of death, fentanyl was detected in 20% (78/390) of deaths in 2013, increasing to 47.5% (274/577) by 2016 (P<0.001).
conclusionsPrescribed, diverted, and illicit opioids all play an important role in opioid related deaths. Although more than half of all opioid related deaths still involved prescription drugs (either dispensed or diverted) in 2016, the increased rate of deaths involving fentanyl between 2015 and 2016 is concerning and suggests the need for a multifactorial approach to this problem that considers both the prescribed and illicit opioid environments.
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