Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada.
BMC Psychiatry. 2013 Jan 4;13:6. doi: 10.1186/1471-244X-13-6.
Morbidity and mortality related to Prescription Opioid Analgesics (POAs) have been rising sharply in North America. Non-Medical Prescription Opioid Use (NMPOU) in the general population is a key indicator of POA-related harm, yet the role of question item design for best NMPOU prevalence estimates in general population surveys is unclear, and existing NMPOU survey data for Canada are limited.
We tested the impact of different NMPOU question items by comparing an item in the 2008 and 2009 (N = 2,017) samples of the CAMH Monitor surveys - an Ontario adult general population survey - with a newly developed item used in the 2010 (N = 2,015) samples of the Centre for Addiction and Mental Health (CAMH) Monitor surveys. To control for a potential difference in the population demographics between surveys, we adjusted for gender, age, region, income, prescription opioid use, cigarette smoking, weekly binge drinking, cannabis use in the past three months, and psychological distress in our analyses.
The prevalence of NMPOU as measured by the 2008 and 2009 CAMH monitor (2.0% [95% CI: 1.2% to 2.8%]) was significantly different when compared to the prevalence of NMPOU as measured by the 2010 CAMH monitor (7.7% [95% CI: 6.3% to 9.2%]) (p < 0.001). This difference was also found when stratifying our analysis by sex (p < 0.001) and when adjusting for all potential confounding covariates.
It is highly unlikely that the extensive NMPOU prevalence differences observed from the different survey items reflect an actual increase of NMPOU or changes in NMPOU determinants, but rather point to measurement effects. It appears that we currently do not have accurate estimates of NMPOU in the Canadian general population, even though these estimates are needed to guide and implement targeted interventions. Given the current substantial morbidity and mortality impact of NMPOU, there is an urgent need to systematically develop, validate and standardize NMPOU items for future general population surveys in Canada.
在北美，与处方阿片类药物（POA）相关的发病率和死亡率急剧上升。普通人群中的非医疗处方阿片类药物使用（NMPOU）是 POA 相关危害的一个关键指标，但最佳普通人群调查中 NMPOU 流行率估计的问题项目设计的作用尚不清楚，而且加拿大现有的 NMPOU 调查数据有限。
我们通过比较 2008 年和 2009 年 CAMH 监测调查（安大略省成人一般人群调查）中的一个项目与新开发的用于 2010 年 CAMH 监测调查（安大略省成人一般人群调查）中的一个项目，测试了不同 NMPOU 问题项目的影响。为了控制调查之间人口统计学差异的潜在影响，我们在分析中调整了性别、年龄、地区、收入、处方阿片类药物使用、吸烟、每周狂饮、过去三个月大麻使用和心理困扰。
2008 年和 2009 年 CAMH 监测（2.0%[95%CI：1.2%至 2.8%]）测量的 NMPOU 患病率与 2010 年 CAMH 监测（7.7%[95%CI：6.3%至 9.2%]）测量的 NMPOU 患病率存在显著差异（p<0.001）。当按性别对分析进行分层时（p<0.001），以及当调整所有潜在混杂协变量时，也发现了这种差异。
从不同的调查项目中观察到的广泛的 NMPOU 流行率差异极不可能反映 NMPOU 的实际增加或 NMPOU 决定因素的变化，而更指向测量效果。似乎我们目前甚至没有加拿大普通人群中 NMPOU 的准确估计值，尽管这些估计值是指导和实施有针对性干预措施所必需的。鉴于 NMPOU 当前对发病率和死亡率的巨大影响，迫切需要系统地开发、验证和标准化加拿大未来普通人群调查中的 NMPOU 项目。
