The impact of prescription opioids on all-cause mortality in Canada

Prescription opioids are mainly used as medications for the treatment of mild to severe pain. In the context of pain care, their consumption levels have risen globally since the 1990s, but the expansions seen in North America have been unmatched elsewhere. Recently published in Substance Abuse, Treatment, Prevention, and Policy, Sameer Imtiaz and Dr Jürgen Rehm comment on comparisons between the US and Canada.

As with other psychoactive substances, expansions in the consumption levels of prescription opioids have been accompanied by several prescription opioid-related problems. For example, data from the United States indicate parallel increases in related non-medical use, treatment admissions and poisoning deaths. These trends are evident in Canada as well.

Most recently, Case and Deaton discovered reversals in all-cause mortality in midlife among white non-Hispanics in the United States. All-cause mortality rates decreased by 2% per year in this group between 1978 and 1998, but increased thereafter by 0.5% per year.

The reversals in all-cause mortality seen in the United States were clearly related to increases in external causes of death, including alcohol and drug poisonings and suicides, as well as liver disease. Although these causes of death are strongly related to the use of other psychoactive substances as well, the non-medical use of prescription opioids was especially emphasized as the underlying risk factor.

The non-medical use of prescription opioids was especially emphasized as the underlying risk factor.

The assessment of similar all-cause mortality trends is also relevant for Canada, given the parallels with the United States in psychoactive substance use, particularly non-medical use of prescription opioids. Case and Deaton included the midlife age group in Canada in their comparisons, but found no reversals in all-cause mortality.

In our recently published commentary in the journal Substance Abuse, Treatment, Prevention and Policy, similar assessments were extended to other age groups in Canada. These assessments were based on publically available databases from the World Health Organization and United Nations.

These assessments indicated that all-cause mortality rates decreased between 1990, 2000 and 2011 for both sexes and all age groups. Despite the decreases in all-cause mortality rates, drug poisoning mortality rates increased in the time period, resulting in strong negative correlations between the two rates.

For Canada, the increases in drug poisoning mortality were not large enough to drive up the all-cause mortality, as was observed by Case and Deaton for white non-Hispanics in the United States. It will be important to further explore the underlying factors and pathways for these divergent findings in neighboring countries with similar use patterns.

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