Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science (IMS), University of Toronto, Toronto, Canada; Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Canada; Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
Drug Alcohol Depend. 2018 Aug 1;189:76-79. doi: 10.1016/j.drugalcdep.2018.04.024. Epub 2018 May 29.
Numerous interventions aimed at addressing the Canadian 'opioid crisis' have been implemented. However, no empirical estimaes of the number of people with problematic prescription opioid (PO) use exist to inform and guide intervention system needs.
The annual numbers of Canadian adults (≥ 15 years) with PO misuse and/or use disorders ('addiction') were estimated by combining data on the prevalence and associated 95% Confidence Intervals (CIs) of PO use in the Canadian population, obtained from national surveys, with PO misuse and use disorders transition probabilities, obtained from high-quality studies in recent meta-analyses. Uncertainty Intervals (UI) were estimated using Monte Carlo simulations.
Population estimates of PO use were highest in 2008, with 5,967,046 (95% CI: 5,635,543-6,326,173) people using POs (representing 21.6% of adults), and lowest in 2015, with 3,941,935 (95% CI: 3,580,842-4,272,937) people using POs (13.1%). Furthermore, PO misuse and use disorders were highest in 2008, with 1,408,223 (95% UI: 878,686-1,951,211; 5.1% of adults) and 525,100 (95% UI 258,288-801,472; 1.9%) people with PO misuse and use disorders respectively. These numbers declined to 930,297 (95% UI: 576,083-1,295,310; 3.1% of adults) and 346,890 (95% UI: 168,310-532,941; 1.2%) people with PO misuse and use disorders, respectively, in 2015.
While seemingly declining over-time, the crude population estimates for problematic PO use were high, likely outweighing current intervention capacities. Furthermore, these estimates do not account for the delay of onset and duration of PO misuse and disorders. Thus, more rigorous problem population estimates should be generated to guide interventions.
为了解决加拿大的“阿片类药物危机”，已经实施了许多干预措施。然而，目前尚无针对有问题的处方类阿片类药物（PO）使用者人数的实证估计，无法为干预系统需求提供信息和指导。
通过结合全国调查中 PO 使用的流行率及其相关 95%置信区间（CI）的数据，以及高质量元分析中 PO 滥用和使用障碍转移概率的数据，来估算加拿大成年人（≥15 岁）中 PO 滥用和/或使用障碍（“成瘾”）的年度人数。使用蒙特卡罗模拟法估算不确定区间（UI）。
2008 年 PO 使用的人群估计值最高，有 5967046 人（95%CI：5635543-6326173）使用 PO（占成年人的 21.6%），2015 年最低，有 3941935 人（95%CI：3580842-4272937）使用 PO（13.1%）。此外，2008 年 PO 滥用和使用障碍的人数最高，分别有 1408223 人（95%UI：878686-1951211；占成年人的 5.1%）和 525100 人（95%UI 258288-801472；占成年人的 1.9%）患有 PO 滥用和使用障碍。到 2015 年，这些数字分别下降至 930297 人（95%UI：576083-1295310；占成年人的 3.1%）和 346890 人（95%UI：168310-532941；占成年人的 1.2%）。
尽管随着时间的推移，有问题的 PO 使用的人群估计数似乎有所下降，但仍然很高，可能超过了当前的干预能力。此外，这些估计并未考虑 PO 滥用和障碍发病时间和持续时间的延迟。因此，应该生成更严格的问题人群估计数来指导干预措施。
