Abstract
BackgroundMorbidity and mortality related to Prescription Opioid Analgesics (POAs) have been rising sharply in North America. Non-Medical Prescription Opioid Use (NMPOU) in the general population is a key indicator of POA-related harm, yet the role of question item design for best NMPOU prevalence estimates in general population surveys is unclear, and existing NMPOU survey data for Canada are limited.MethodsWe tested the impact of different NMPOU question items by comparing an item in the 2008 and 2009 (N = 2,017) samples of the CAMH Monitor surveys – an Ontario adult general population survey – with a newly developed item used in the 2010 (N = 2,015) samples of the Centre for Addiction and Mental Health (CAMH) Monitor surveys. To control for a potential difference in the population demographics between surveys, we adjusted for gender, age, region, income, prescription opioid use, cigarette smoking, weekly binge drinking, cannabis use in the past three months, and psychological distress in our analyses.ResultsThe prevalence of NMPOU as measured by the 2008 and 2009 CAMH monitor (2.0% [95% CI: 1.2% to 2.8%]) was significantly different when compared to the prevalence of NMPOU as measured by the 2010 CAMH monitor (7.7% [95% CI: 6.3% to 9.2%]) (p < 0.001). This difference was also found when stratifying our analysis by sex (p < 0.001) and when adjusting for all potential confounding covariates.ConclusionIt is highly unlikely that the extensive NMPOU prevalence differences observed from the different survey items reflect an actual increase of NMPOU or changes in NMPOU determinants, but rather point to measurement effects. It appears that we currently do not have accurate estimates of NMPOU in the Canadian general population, even though these estimates are needed to guide and implement targeted interventions. Given the current substantial morbidity and mortality impact of NMPOU, there is an urgent need to systematically develop, validate and standardize NMPOU items for future general population surveys in Canada.
Highlights
Morbidity and mortality related to Prescription Opioid Analgesics (POAs) have been rising sharply in North America
A key epidemiological indicator of POA-related problems is the prevalence of Non-Medical Prescription Opioid Use (NMPOU), which is defined as using POAs when they are not prescribed by a physician, or using POAs for purposes other than as prescribed; the definition of NMPOU excludes the underuse of POAs
The NMPOU item run in the 2010 wave of the Centre for Addiction and Mental Health (CAMH) Monitor survey had valid data for n = 2,015
Summary
Morbidity and mortality related to Prescription Opioid Analgesics (POAs) have been rising sharply in North America. The Canadian Alcohol and Other Drug Use Monitoring Survey (CADUMS) initially surveyed NMPOU in the Canadian general adult population (15+ years) in 2008 based on the following questions: 1) “During the past 12 months, did you ever use pain relievers for the feelings [they] caused or to get high?”, and/ or 2) Were the pain relievers used during the past 12 months obtained from i) “a prescription written for someone else such as a family member or a friend,” ii) “bought from someone else, without a prescription,” iii) “from any other source” [10]. The CADUMS found an NMPOU prevalence of 0.4%, which amounted to about one-tenth of the NMPOU prevalence of 4.8% estimated for the United States (U.S.) general youth and adult (12+ years) population in 2008 by the National Survey on Drug Use and Health (NSDUH) [11,12]
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