From 2003 through 2020, as opioid-related mortality in Ontario, Canada increased five-fold, the age distribution also shifted downward – with rates now peaking for people in their mid-30s – according to a new study published in PLOS ONE.
Led by Patrick Brown, Associate Professor in the Department of Statistical Sciences, University of Toronto, the study used mortality data from the Office of the Chief Coroner for Ontario and applied novel statistical methods to analyse how the demographic makeup of deaths has changed over time.
“For this study we wanted to look at opioid mortality over time and take a deeper dive into data than many have before,” said Brown who explained that often official data is rounded to five-year age groups which can blur important details. “The data provided by the Chief Coroner is also very timely and gives us a more accurate picture of what’s happening now and who is being impacted which can ultimately help inform policy.”
Specifically, the study found that from 2003 to 2020, there were 11,633 opioid-related deaths in Ontario aged 15 through 69. Overall, 72 per cent of opioid-related deaths during the study period were male, and accidental deaths accounted for 82 per cent of the deaths. Using a Bayesian modelling approach, the authors estimate that in 2003, mortality rates reached maximums at 5.5 deaths per 100,000 person-years for males around age 44 and 2.2 deaths per 100,000 person-years for females around age 51. As of 2020, rates have reached maximums at 67.2 deaths per 100,000 person-years for males around age 35 and 16.8 deaths per 100,000 person-years for females around age 37.
“We are seeing that deaths increased across all age categories but that twenty years ago, most deaths were occurring in people aged 40 to 50. Now we are observing a drop in age where most deaths are occurring among people in their 30s,” Brown said.
From left: Associate Professor Patrick Brown, Department of Statistical Sciences, University of Toronto and Assistant Professor Tara Gomes, Leslie Dan Faculty of Pharmacy, University of Toronto
The study authors point to several changes that may be influencing this trend. Large increases in mortality involving opioid drugs were initially attributed to over-prescribing of opioids for pain. Following widespread recognition of the risks of opioids and increased efforts in monitoring and regulation of prescribing practices, several regions observed some stabilization or decline in deaths from prescription opioids. However, due to the emergence of highly potent non-pharmaceutical opioid drugs such as fentanyl, deaths from synthetic opioids have continued to rise.
“Despite changes in opioid prescribing practices, rates of deaths related to opioids continue to worsen across North America, largely because of the current highly toxic unregulated drug supply,” said Tara Gomes, an epidemiologist and Assistant Professor at the Leslie Dan Faculty of Pharmacy, University of Toronto. Other research in this area led by Gomes showed that, during the onset of the COVID-19 pandemic, approximately one-third of people who died of opioid toxicity did not have an opioid use disorder diagnosis. “This suggests that a meaningful portion of people affected by the overdose crisis are only intermittently using drugs. As the drug supply is getting more unpredictable, I’m concerned that our response to this crisis is missing the needs of a younger population of people who are using drugs occasionally and are therefore not eligible for certain treatment options or do not have ready access to existing harm reduction services,” said Gomes who is also Principal Investigator of the Ontario Drug Policy Research Network (ODPRN).
Study estimates deaths among younger population will continue to grow
Based on the study’s modelling, researchers estimate that opioid-related mortality among the younger population will continue to grow and increase along the current trajectory. “There has been investment in harm reduction services in Ontario, but the problem is that often these services are few and far between, and primarily located in urban centres. We need to be more creative in the services we offer and more effective in ensuring equitable access across the province,” said Gomes who sees potential in pushing beyond a medicalized approach, with careful thought and consideration. “We need to look at decriminalization of drugs for personal use and non-medicalized approaches to addressing this crisis, including expanded access to safer alternative drug supplies that are not fully reliant on access through clinicians.”
The impact of the COVID-19 pandemic on opioid-related deaths continues to be a concern, said Brown. “The opioid problem is causing a lot of deaths and, in some ways, this has been overshadowed by COVID, but it is still growing at its previous rate and we will need to come together and start focusing efforts on this again,” he said.
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