Nicholas B. King is with the Biomedical Ethics Unit and the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec. Veronique Fraser is with the Biomedical Ethics Unit, McGill University. Constantina Boikos, Robin Richardson, and Sam Harper are with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University.
We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013. We identified 17 determinants of opioid-related mortality and mortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult. Preventing additional opioid-related mortality will likely require interventions that address multiple determinants and are tailored to specific locations and populations.
Cites: Pharmacoepidemiol Drug Saf. 2008 Oct;17(10):997-100518512264
Cites: JAMA. 2008 Dec 10;300(22):2613-2019066381
Cites: JAMA. 2008 Dec 10;300(22):2672-319066389
Cites: Am J Addict. 2009 Jan-Feb;18(1):5-1419219660
Cites: Addiction. 2009 Sep;104(9):1541-819686524
Cites: MMWR Morb Mortal Wkly Rep. 2009 Oct 30;58(42):1171-519875978
Cites: PLoS One. 2009;4(11):e775819924221
Cites: Pharmacoepidemiol Drug Saf. 2009 Dec;18(12):1166-7519718704
Cites: CMAJ. 2009 Dec 8;181(12):891-619969578
Cites: Ann Intern Med. 2010 Jan 19;152(2):85-9220083827
Cites: BMC Med. 2010;8:820089155
Cites: MMWR Morb Mortal Wkly Rep. 2010 Feb 19;59(6):153-720168293