Grant: Project Grant

With more than 30,000 deaths over the past 20 years, the opioid crisis is one of the greatest public health crises in Canadian history. It consists of two distinct but overlapping elements: opioid addiction and its consequences, and harms arising from the treatment of pain with opioids such as codeine, morphine, oxycodone and others. Unfortunately, despite two decades of liberal opioid prescribing, important questions remain about the safety of opioids as currently prescribed. In this grant, we will conduct 5 studies to generate new insights about the safety of opioid pain medicines. To do this, we will link several large healthcare databases (pharmacy prescription claims, emergency department visits, hospital admissions, doctor visits, opioid fatalities from coroner's data, and others) for the entire population of Ontario over many years to explore the following questions: 1. Does the treatment of pain with opioids increase the risk of infection? 2. After spine surgery, what are the risks of fatal and nonfatal opioid overdose? 3. In women prescribed opioids following childbirth: a) has codeine (a weak opioid) been progressively replaced by oxycodone (a much stronger and more dangerous opioid)? b) is new, ongoing opioid use more likely among new mothers started on oxycodone after delivery, as compared to codeine? c) do opioids prescribed to women after childbirth pose any risk to the newborn, via passage through breast milk? Our team has extensive experience in the conduct of this sort of research, collectively publishing hundreds of studies over the past 15 years. Over the past 10 years our group has been at the forefront of opioid safety research, informing policy nationally and internationally. The studies proposed in this application are novel, feasible in few research institutes worldwide, and relevant to the health of millions of people in Canada and elsewhere.