Grant: Project Grant

The overall goal of this project is to assess patterns of opioid prescription in BC in relation to serious outcomes (e.g. dependence, illicit drug use, overdose, and death) and provide evidence for do-no-harm strategies to address BC's prescription opioid crisis. In 2016 in BC, there were 978 illicit drug overdose deaths and, in the first half of 2017, another 780 deaths. This is the highest number of drug overdose deaths ever recorded and BC announced a Public Health Emergency in April 2016. Currently, many drugs sold illicitly contain fentanyl, an opioid that is many times more potent than heroin. Fentanyl detection in illicit drug deaths has risen from 4% in 2012 to 81% in 2017 to date. The dramatic increase in illicit drug deaths over time is, in part, due to policies designed to address problematic prescription opioid use. Currently, a half a million British Columbians are prescribed opioids for non-cancer pain each year and the quantities of opioids prescribed have risen dramatically over time. Numerous recommendations have been developed including prescription drug monitoring programs that help prescribers know if their patients are taking high amounts of opioids, dangerous drug combinations, or being prescribed opioids inappropriately; and accelerating requirements for tamper-resistant formulations of medications. However limited evidence suggests the possibility of unintended consequences which could increase the illicit drug death rate. Thus, recent reports have called for a better understanding of the relationship between prescription opioid misuse and illicit opioid use for informing prevention and treatment initiatives. This study will address the relationship between prescription drug use, illicit drug use, and harms secondary to drug use. We plan to evaluate patterns of opioid prescribing and drug taking behaviours in relation to serious outcomes and evaluate the effects of supply interventions, opioid agonist therapy, and public policy on changes