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A review of nearly 300,000 Fraser Health Emergency Department visits for injury between 2012 and 2018 sheds new light on the risk that people are likely to experience an illicit drug overdose (drug poisoning) following prescription of opioids after their injury.

Risk of non-medical drug overdose following prescription of opioids post-injury: A retrospective cohort study is a collaboration between Fraser Health, the City of Surrey, UBC and the BC Injury Research and Prevention Unit. The study explores the relationship between injury, opioid prescribing and drug poisoning. It uses information from large databases to identify potential strategies for early intervention.

“In recent years there has been a reluctance to prescribe opioids following an injury due to concerns about dependency or risk of overdose. Our data suggest that for those prescribed opioids who haven’t received them previously, there is an increased risk of drug poisoning from an opioid prescription, but this risk is lower than other known contributing factors like younger age, being male and lower income,” says Dr. Aamir Bharmal, study co-author and medical health officer, Fraser Health.

Key findings of the study include:

  • Seventy percent of people who visited the Emergency Department with an injury were not prescribed opioids. The most important predictor for being prescribed opioids following an injury was having been prescribed opioids prior to the injury.
  • For those with no known history of opioid use, those prescribed opioids for an injury following an emergency department visit were 27 per cent more likely to suffer a non-medical drug poisoning than those who were not prescribed opioids or opioid agonist therapy (OAT).
  • Men under 35 in lower income brackets have the highest risk of overdose. This is consistent with data from the B.C. Coroner’s Service indicating that men between 30-39 years of age suffer the most overdose deaths, with decreasing rates for older age groups.

The report also examines the role of opioid prescribing for workplace injuries.

While some literature suggests that workers injured on the job are at higher risk of overdose than their non-injured counterparts, the data show that injuries occurring outside of the workplace pose a higher drug poisoning risk.

People injured on the job were 18 per cent less likely to be prescribed opioids and 38 per cent less likely to suffer a drug poisoning event than those who sustained injuries outside of the workplace.

“We found that to some extent, being injured on the job had a protective effect,” says Dr. Ian Pike, professor in the University of British Columbia’s Department of Pediatrics and director of the BC Injury Research and Prevention Unit. “It’s possible that more frequent monitoring of workers along with better access to non-pharmaceutical pain management and allied health services may lead to improved recovery and lower risk of drug poisoning.”

The research team recommends careful consideration be given to prescribing opioids for the purposes of pain management following injury, especially for those most at risk — those with known opioid dependence or opioid use disorder. For those at highest risk in pain, researchers advocate for mental health supports, such as counselling, and active monitoring given the impact that stressful life events, like unmanaged pain, can have on drug relapse and poisoning risk.

“Especially for those on OAT, we need to ensure an individual’s pain needs are met and they are not turning to the toxic drug supply," says Dr. Bharmal. “Doing so has tragic consequences, and leads to more drug poisoning deaths.”

About Fraser Health: responsible for the delivery of hospital and community-based health services to over 1.9 million people in 20 diverse communities from Burnaby to Fraser Canyon on the traditional territories of the Coast Salish and Nlaka’pamux Nations. Our team of nearly 43,000 staff, medical staff and volunteers is dedicated to serving our patients, families and communities to deliver on our vision: Better health, best in health care.

About BC Injury Research and Prevention Unit: works to reduce the societal and economic burden of injury across all age groups in British Columbia through research, surveillance, education and knowledge transfer, public information, and the support of evidence-based, effective prevention measures. BCIRPU plays a central role in coordinating and supporting injury prevention initiatives throughout the province and Canada. The Unit is located at BC Children’s Hospital in Vancouver, Canada, and is a core research program within the BC Children’s Hospital Research Institute’s Evidence to Innovation Theme.

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