Overdose Risk and Acquiring Opioids for Nonmedical Use Exclusively from Physicians in Vancouver, Canada

Abstract

Background

A primary response to the alarming rise in overdose and mortality due to nonmedical prescription opioid (PO) use has been to restrict opioid prescribing; however, little is known about the relationship between obtaining opioids from a physician and overdose risk among people who use POs nonmedically and illicit street drugs. Objectives: Investigate the relationship between non-fatal overdose and acquiring POs exclusively from physicians for the purposes of engaging in nonmedical PO use. Methods: Data were collected between 2013 and 2016 among participants in two harmonized prospective cohort studies of people who use drugs in Vancouver: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Analyses were restricted to participants who engaged in nonmedical PO use and used generalized estimating equations. Results: Among 599 participants who used POs nonmedically, 82 (14%) individuals reported acquiring POs exclusively from a physician and 197 (33%) experienced a non-fatal overdose at some point over the study period. Acquiring POs exclusively from physicians was significantly and negatively associated with non-fatal overdose in the bivariate analysis (Odds Ratio = 0.60, 95% Confidence Interval (CI): 0.39–0.94) but not the final multivariate analysis (Adjusted Odds Ratio =0.87, 95% CI: 0.53–1.44). Conclusions: Compared to individuals who acquired POs from friends or the streets, participants who acquired POs exclusively from a physician were not at an increased risk of non-fatal overdose. Although responsible opioid prescribing is an important priority, additional strategies to address nonmedical PO use are urgently needed to reduce overdose and related morbidity and mortality.

Keywords:

• Nonmedical prescription opioid use
• street youth
• substance dependence
• risk behavior
• overdose

Acknowledgements

The authors thank the ARYS and VIDUS study participants for their contribution to the research, as well as current and past researchers and staff. The study was supported by the US National Institutes of Health (U01DA038886) and the Canadian Institutes of Health Research (MOP–286532). Dr. Kora DeBeck is supported by a MSFHR / St. Paul’s Hospital Foundation–Providence Health Care Career Scholar Award and a Canadian Institutes of Health Research New Investigator Award. Dr. Will Small is supported by a Michael Smith Foundation for Health Research Career Investigator Scholar Award. Dr. Kanna Hayashi is supported by a CIHR New Investigator Award (MSH-141971), a Michael Smith Foundation for Health Research (MSFHR) Scholar Award, and the St. Paul’s Foundation.

Declaration of interest

No potential conflict of interest was reported by the authors.