Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone
Humans; Analgesics; Ontario/epidemiology; Oxycodone/therapeutic use; Delivery of Health Care/utilization; Mortality/trends; Opioid/poisoning/therapeutic use; Poisoning/mortality/prevention & control; Prescription Drugs/poisoning/therapeutic use
INTRODUCTION: Opioid-related mortality appears to be increasing in Canada. We examined the true extent of the problem and the impact of the introduction of long-acting oxycodone. METHODS: We examined trends in the prescribing of opioid analgesics in the province of Ontario from 1991 to 2007. We reviewed all deaths related to opioid use between 1991 and 2004. We linked 3271 of these deaths to administrative data to examine the patients' use of health care services before death. Using time-series analysis, we determined whether the addition of long-acting oxycodone to the provincial drug formulary in January 2000 was associated with an increase in opioid-related mortality. RESULTS: From 1991 to 2007, annual prescriptions for opioids increased from 458 to 591 per 1000 individuals. Opioid-related deaths doubled, from 13.7 per million in 1991 to 27.2 per million in 2004. Prescriptions of oxycodone increased by 850% between 1991 and 2007. The addition of long-acting oxycodone to the drug formulary was associated with a 5-fold increase in oxycodone-related mortality (p<0.01) and a 41% increase in overall opioid-related mortality (p=0.02). The manner of death was deemed unintentional by the coroner in 54.2% and undetermined in 21.9% of cases. Use of health care services in the month before death was common: for example, of the 3066 patients for whom data on physician visits were available, 66.4% had visited a physician in the month before death; of the 1095 patients for whom individual-level prescribing data were available, 56.1% had filled a prescription for an opioid in the month before death. INTERPRETATION: Opioid-related deaths in Ontario have increased markedly since 1991. A significant portion of the increase was associated with the addition of long-acting oxycodone to the provincial drug formulary. Most of the deaths were deemed unintentional. The frequency of visits to a physician and prescriptions for opioids in the month before death suggests a missed opportunity for prevention.
2009
Dhalla IA; Mamdani M; Sivilotti ML; Kopp A; Qureshi O; Juurlink DN
Canadian Medical Association Journal
2009
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1503/cmaj.090784" target="_blank" rel="noreferrer">10.1503/cmaj.090784</a>
Healthcare Users' Experiences of Communicating with Healthcare Professionals About Children Who Have Life-Limiting Conditions: A Qualitative Systematic Review
The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, “healthcare users” will be taken to include children who have life-limiting conditions and their families. The question to be addressed is: Review question/objective What are healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions? Background The prospect of the death of a child from an incurable medical condition is harrowing, yet finding a way to discuss this prospect is crucial to maximize the quality of life for such children and their families. High-quality communication is well recognized as a core skill health care professionals need to maximize the quality of care they provide.1-15 This skill is valued by service users, who consistently rate it as one of the highest priorities for the care they receive.5-8,15 Evidence suggests, however, that healthcare professionals can feel ill-equipped or uncomfortable communicating with and about such children.11,16-18 Therefore, it is important to understand what represents high-quality communication and what is involved in accomplishing this within pediatric palliative care. Background In recent decades there has been an increased focus on providing palliative care for children who have life-limiting conditions.9,15,19-23 These are conditions for which no cure is available and for which the probable outcome is premature death.24 Palliative care may also be appropriate for children who have life-threatening conditions; these are conditions where there is not only a high probability of premature death but also a chance of long-term survival into adulthood24 Although pediatric palliative care is underpinned by the same philosophy as adult palliative care,9,24 children who have life-limiting conditions and their families have particular needs that distinguish them from users of adult palliative care.15 For example, at a physical level children are more likely than adults to have non-malignant conditions that follow trajectories in which children oscillate between feeling relatively well and acutely unwell.9,15,25 The social dynamic of their care is also radically different, particularly given the role of parents or guardians in making surrogate decisions about their child's care.15,26-29 Such factors warrant considering pediatric palliative care as distinct from palliative care more generally
Ekberg S; Bradford N; Herbert A; Danby S; Yates P
Journal of Palliative Medicine
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.11124/jbisrir-2015-2413" target="_blank" rel="noreferrer noopener">10.11124/jbisrir-2015-2413</a>