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Citation
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Lam T, Hayman J, Berecki-Gisolf J, Sanfilippo P, Lubman DI, Nielsen S. Addiction 2021; ePub(ePub): ePub. |
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Abstract
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BACKGROUND AND AIMS: Pharmaceutical opioids are a significant contributor to the global 'opioid crisis', yet few studies have comprehensively distinguished between opioid types. We measured whether a range of common pharmaceutical opioids varied in their contribution to the rates and characteristics of harm in a population-wide indicator of non-fatal overdose.
DESIGN: Retrospective observational study of Emergency Department (ED) patient care records in the Victorian Emergency Minimum Dataset (VEMD), July 2009 to June 2019. SETTING: Victoria, Australia. CASES: ED presentations for non-fatal overdose related to pharmaceutical opioid use (n=5403), where the specific pharmaceutical opioid was documented. MEASUREMENTS: We compared harms across the nine individual pharmaceutical opioids most commonly sold, and considered where multiple opioids contributed to the overdose. We calculated supply-adjusted rates of ED presentations using Poisson regression and used multinomial logistic regression to compare demographic and clinical characteristics of presentations across nine distinct pharmaceutical opioids and a tenth category where multiple opioids were documented for the presentation.
FINDINGS: There were wide differences, up to 27 fold, between supply-adjusted rates of overdose. When considering presentations with sole opioids, the highest supply-adjusted overdose rates (per 100 000 Oral Morphine Equivalents [OME]; 95% confidence interval (CI)) were for codeine (0.078 [0.073-0.08]) and oxycodone (0.029 [0.027-0.030]) and the lowest were for tapentadol (0.004 [0.003-0.006]) and fentanyl (0.003 [0.002-0.004]). These rates appeared related to availability rather than opioid potency. Most poisonings involved females (62%), with codeine, oxycodone and tramadol all associated with younger presentations (>40% 12-34 years old) and intentional self-harm (>50%). Relative to morphine, fentanyl (<0.32 Relative Risk Ratio [RRR]) and methadone (<0.58 RRR) presentations were less likely to be coded as self-harm. Relative to morphine - buprenorphine, codeine, oxycodone, and tramadol presentations were significantly more likely to be associated with the less urgent triage categories (>1.50 RRR).
CONCLUSIONS: In Victoria, Australia, rates and characteristics of emergency department presentations for pharmaceutical opioids show distinct variations by opioid type.
Language: en |