Learning Objectives
By the end of this topic, the student should be able to:
- Define opioid use, opioid use disorder, and common types of opioid misuse.
- Describe the epidemiology and consequences of opioid use disorder in Canada.
- Explain the short- and long-term effects of opioid use.
- Describe the economic impact of the opioid crisis on individuals and communities.
Key Concepts
- Canada ranks second to the United States in countries with the highest levels of opioid use (International Narcotics Control Board, 2020).
- According to the Public Health Agency of Canada, more than 13,900 Canadians died from an apparent opioid-related overdose between January 2016 and June 2019 (Special Advisory Committee on the Epidemic of Opioid Overdoses, 2019).
- Between January and June 2019, most opioid-related deaths in Canada were accidental (94 percent).
- Opioid consumption has a 5.5 percent risk of developing into opioid use disorder and is associated with an increased likelihood of overdosing at higher doses.
- Opioid use can have a negative impact at a personal, societal, and economic level.
Concerns Around Opioid Use
Opioids can produce a feeling of euphoria or a “high” and are prescribed for pain relief. There is a legitimate public health concern about opioids prescribed for pain relief as approximately 20 percent of the Canadian population experiences chronic pain (Schopflocher et al., 2011).
Opioid use can lead to harms, including opioid use disorder, poisoning, motor vehicle accidents, social and emotional problems, suicide, and death.
Canada is currently experiencing an opioid crisis. The over-prescribing of opioids to manage chronic pain has contributed to the crisis.
- In 2016, one in eight people across most provinces were prescribed an opioid medication for pain-related symptoms (Canadian Institute for Health Information, 2019).
- Opioid use disorder is complicated because it is influenced by factors outside an individual, such as:
- the high availability of prescription opioids and,
- more recently, illicitly manufactured synthetic opioids (e.g., fentanyl).
Definition
- Prescription Opioid Misuse
- Prescription opioid misuse is defined as opioid use that is contrary to the directed or prescribed pattern of use, regardless of the presence or absence of harm or adverse effects (Vowles et al., 2015).
Opioid misuse can be grouped into several categories (American College of Preventative Medicine, 2011):
- not taking the medication according to the prescription,
- unsanctioned use (running out early, bingeing),
- alteration of the route of delivery (injecting, crushing tablets, snorting, chewing),
- accessing of drugs from other sources (friend, the street, other doctors),
- drug-seeking behaviour (anger, harassing office staff for fit-in appointments), and
- reluctance to use other methods of pain management.
Please take the time to explore the following examples of lives impacted by prescription opioid misuse.
Some people might seek prescription opioids to treat pain symptoms and may increase their prescription dosage (if they have one) without consulting their physician or nurse practitioner by doing the following:
- taking different types of opioids if they feel their prescription does not adequately alleviate their symptoms,
- going to more than one doctor to get the same drug, or buying drugs on the street, or
- smoking, snorting, crushing, or injecting the drug to feel the effects of the drug faster and more intensely if they feel they have developed a tolerance.
Spectrum of Substance Use
Beneficial Use
- Use that has positive health, spiritual or social effects
- E.g., pharmaceuticals; coffee/tea to increase alertness; moderate consumption of red wine; sacramental use of ayahuasca or peyote
Casual/Non-problematic Use
- Recreational, casual or other use that has negligible health or social effects
Problematic Use
- Use that begins to have negative health consequences for individual, family/friends, or society
- E.g., impaired driving; binge consumption; harmful routes of administration
Chronic Dependence
- Use that has become habitual and compulsive despite negative health and social effects
Adapted from (British Columbia Ministry of Health Services, 2004)
Statistics of Opioid Use in Canada
Canada ranks second in countries with high opioid use (International Narcotics Control Board, 2020). In 2017, it was reported that approximately one out of seven people in Ontario (almost 2 million people) filled an opioid prescription (Canadian Centre on Substance Abuse and Addiction, 2017).
- Non-medical use of prescribed opioids is now the fourth most prevalent form of substance use in Canada, behind alcohol, tobacco, and cannabis (Belzak & Halverson, 2018).
- According to the Public Health Agency of Canada (Special Advisory Committee on the Epidemic of Opioid Overdoses, 2019), approximately 15,393 Canadians died from an apparent opioid-related overdose between January 2016 and December 2019.
- Between January and June 2019, most opioid-related deaths were accidental (94 percent).
- 77 percent of apparent opioid-related deaths involved fentanyl or fentanyl analogues.
- The rate of opioid use for pain relief among Canadian adults was 12.3 percent in 2018. That had decreased slightly from 2013, when 14.3 percent reported using opioid medications (Canadian Institute for Health Information, 2019).
- There have been select improvements from surveillance and monitoring indicators for opioid-related harms in Canada, although many of these indicators remain limited in scope and coverage.
For an up-to-date picture of the status of opioid-related harms in Canada, please take a moment to visit the Government of Canada Public Health Infobase describing Opioid-related harms in Canada.Pay special attention to the statistics under “Deaths”.
Short- and Long-Term Effects of Opioid Use
Opioid use can have a negative impact at the individual, societal, and economic level.
NOTE: For information on the biomedical short- and long-term adverse effects of opioids see Module 1, Topic I.
Opioid consumption has a 5.5 % risk of developing into an addiction (opioid use disorder) (Canadian Psychological Association, 2019).
Opioid consumption is also associated with an increased likelihood of overdosing at higher doses (Canadian Psychological Association, 2019).
Impact on the Individual
On an individual level, those with opioid use or opioid use disorder might experience negative health effects such as
- liver and neurological damage,
- extreme changes in moods and behaviour, and
- isolation from friends and family.
Impact on Society
On a societal level, opioid use or opioid use disorder can increase
- marginalization and loss of social cohesion
- family break down
- absenteeism from school and work and
- criminal activity.
Impact on the Economy
Over time, the economic costs of opioid use can be exorbitant; they include costs related to losses in productivity and unemployment, increased use of health and social services, increased criminal justice system involvement, and increased government enforcement (Canadian Substance Use Costs and Harms Scientific Working Group, 2018).
In the United States, opioid users consumed more medical services and more prescription drugs than non-users (Meyer et al., 2014). Compared to non-users, users were:
- 78 times as likely to have had an episode of non-opioid poisoning
- 36 times as likely to have hepatitis A, B, or C
- 43 times as likely to have other substance abuse diagnoses
- 21 times as likely to have had pancreatitis
- 8.5 times as likely to have a psychiatric diagnosis
- 4 times as likely to visit the emergency room
- Compared to non-users, users had 12 times as many hospital stays and 63 times as many outpatient visits.
The total economic burden of opioid use was estimated at US$8.6 billion in 2001, a number that increased to US$2.5 trillion from 2015 to 2018 (Council of Economic Advisers, 2019).
Health care costs are significantly higher for those with opioid use disorder than for those who do not use opioids.
Workplace costs included loss of potential earnings, reduced wages, lower employment, and loss of productivity of workers who used prescription opioids.
Criminal justice system costs are higher due to opioid-related criminal activity.
Take a moment to review the 2014 Canadian Substance Use Cost and Harms infographics.You can review the information on a national level or take a look at the provincial or territorial level.
Questions
References
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British Columbia Ministry of Health Services (2004). Every Door is the Right Door. A British Columbia Planning Framework to Address Problematic Substance Use and Addiction. https://www.health.gov.bc.ca/library/publications/year/2004/framework_for_substance_use_and_addiction.pdf
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