Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC V6B 5K3, Canada.
Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand.
Int J Environ Res Public Health. 2021 Jul 14;18(14):7507. doi: 10.3390/ijerph18147507.
Canada is experiencing an epidemic of opioid-related mortality, with increasing yet heterogeneous fatality patterns from illicit/synthetic (e.g., fentanyl) opioids. The present study examined whether differential provincial reductions in medical opioid dispensing following restrictive regulations (post-2010) were associated with differential contributions of fentanyl to opioid mortality. Annual provincial opioid dispensing totals in defined daily doses/1000 population/day, and change rates in opioid dispensing for the 10 provinces for (1) 2011-2018 and (2) "peak-year" to 2018 were derived from a pan-Canadian pharmacy-based dispensing panel. Provincial contribution rates of fentanyl to opioid-related mortality (2016-2019) were averaged. Correlation values (Pearson's R) between provincial changes in opioid dispensing and the relative fentanyl contributions to mortality were computed for the two scenarios. The correlation between province-based changes in opioid dispensing (2011-2018) and the relative contribution of fentanyl to total opioid deaths (2016-2019) was -0.70 ( = 2.75; df = 8; = 0.03); the corresponding correlation for opioid dispensing changes ("peak-year" to 2018) was -0.59 ( = -2.06; df = 8; = 0.07). Provincial reductions in medical opioid dispensing indicated (near-)significant correlations with fentanyl contribution rates to opioid-related death totals. Differential reductions in pharmaceutical opioid availability may have created supply voids for nonmedical use, substituted with synthetic/toxic (e.g., fentanyl) opioids and leading to accelerated opioid mortality. Implications of these possible unintended adverse consequences warrant consideration for public health policy.
加拿大正经历阿片类药物相关死亡的流行，非法/合成（例如芬太尼）类阿片药物导致的死亡率呈不断增加但存在差异的趋势。本研究旨在探究，在实施限制类法规（2010 年后）后，各省医疗用阿片类药物配给量的差异减少是否与芬太尼对阿片类药物死亡率的差异贡献有关。通过对全加范围内的基于药店的配药面板，我们获取了 10 个省份在以下两个时间段内的年度总阿片类药物配药量（以限定日剂量/每 1000 人/天为单位）和配药量变化率：（1）2011-2018 年，（2）“高峰年”至 2018 年。平均计算了这 10 个省份中芬太尼对阿片类药物相关死亡率的贡献率。计算了在上述两个时间段内，各省阿片类药物配药量变化与死亡率中芬太尼相对贡献之间的相关值（皮尔逊 R）。基于各省的阿片类药物配药量变化（2011-2018 年）与芬太尼对总阿片类药物死亡人数的相对贡献之间的相关性为-0.70（=2.75；df=8；p=0.03）；与阿片类药物配药量变化（“高峰年”至 2018 年）之间的相关性为-0.59（=-2.06；df=8；p=0.07）。医疗用阿片类药物配药量的减少与芬太尼对阿片类药物相关死亡总数的贡献率呈（接近）显著相关。制药类阿片类药物供应的减少可能导致了非医疗用途的供应空白，转而使用了合成/有毒（例如芬太尼）类阿片类药物，从而导致阿片类药物死亡率的加速上升。对于这些可能出现的非预期的不良后果，公共卫生政策应该进行考虑。
