Prescription Opioid Use, Harms andInterventions in Canada: A Review Update ofNew Developments and Findings since 2010
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
BACKGROUND: Canada has featured the second-highest levels of prescription opioid (PO) use globally behind the United States, and reported extensive PO-related harms (e.g., non-medical PO use [NMPOU], PO-related morbidity and mortality). A recent comprehensive review synthesized key data on PO use, PO-related harms, and interventions in Canada, yet a substantive extent of new studies and data have emerged. OBJECTIVE: To conduct and present a comprehensive review update on PO use, PO-related harms, and interventions in Canada since 2010. STUDY DESIGN: Narrative review METHODS: We conducted literature searches, employing pertinent keywords, in key databases, focusing on PO-related studies/data in/for Canada since 2010, or pertinent studies/data from earlier periods not included in our previous review. In addition, we identified relevant data from "grey" literature (e.g., government, survey, other data or system reports). Relevant data were screened and extracted, and categorized into 4 main sections of indicators: 1) PO dispensing and use, 2) non-medical PO use, 3) PO-related morbidity/mortality, 4) PO-related interventions and impacts. RESULTS: PO-dispensing in Canada overall continued to increase and/or remain at high levels in Canada from 2010 to 2013, with the exception of the province of Ontario where marked declines occurred starting in2012; quantitative and qualitative PO dispensing patterns continued to vary considerably between provinces. Several studies identified common "high PO dosing" prescribing practices in different settings. Various data suggested declining NMPOU levels throughout most general (e.g., adult, students), yet not in special risk (e.g., street drug users, First Nations) populations. While treatment demand in Ontario plateaued, rising PO-related driving risks as well as neo-natal morbidity were identified by different studies. PO-related mortality was measured to increase--in total numbers and proportionally--in various Canadian jurisdictions. Select reductions in general PO and/or high-dose PO dispensing were observed following key interventions (e.g., Oxycodone delisting, prescription monitoring program [PMP] introduction in Ontario/British Columbia). While physician education intervention studied indicated mixed outcomes, media reporting was found to be associated with PO prescribing patterns. LIMITATIONS: The present review did not utilize systematic review standards or meta-analytic techniques given the large heterogeneity of data and outcomes reviewed. CONCLUSIONS: Recently emerging data help to better characterize PO-related use, harm and intervention indicators in Canada's general context of comparatively high-level PO dispensing and harms, yet major gaps in monitoring and information persist; this continues to be a problematic challenge, especially given the implementation of key PO-related interventions post-2010, the impact of which needs to be properly measured and understood.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it