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A decade of extreme oscillations in opioid control and availability: implications for public health in a Canadian setting

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Abstract

We comment on developments in and impacts of medical opioid control and availability in the province of British Columbia (Canada). Population-level dispensing of (strong) prescription opioids doubled in 2005–2011, yet subsequently declined by half 2011–2018 following implementation of various opioid control measures. Notwithstanding this inversion, BC has featured the highest population rates of opioid-related mortality and morbidity in Canada. The erratic opioid availability patterns presumably facilitated major increases in opioid misuse, morbidity, and mortality. Tangible benefits for pain care from increased medical opioid availability remain un-evidenced. Rather, recent decreases in medical opioid dispensing have not been matched by equivalent reductions in demand for (non-)medical use yet have coincided with widespread proliferation of toxic, illicit opioid supply and related major increases in opioid-related mortality. These developments appear to have undermined rather than benefitted public health and offer a poignant case study in ineffective psychotropic drug control and public health policy towards preventing similar experiences elsewhere.

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Acknowledgements

The present work was partly supported by grant funding from the Canadian Institutes of Health Research (CIHR;#SAF-94814). Dr. Fischer acknowledges research support from the Hugh Green Foundation Chair in Addiction Research, Faculty of Medical and Health Sciences, University of Auckland. Dr. Wood is supported by CIHR through the Canada Research Chairs program. The authors acknowledge Ms. Lenka Vojtila’s skilled support in assembling this manuscript.

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Authors and Affiliations

  1. Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Benedikt Fischer

  2. Department of Psychiatry, University of Toronto, Toronto, Canada

    Benedikt Fischer

  3. Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada

    Benedikt Fischer

  4. Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil

    Benedikt Fischer

  5. British Columbia Centre on Substance Use (BCCSU), Vancouver, Canada

    Evan Wood

  6. Department of Medicine, University of British Columbia, Vancouver, Canada

    Evan Wood

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Correspondence to Benedikt Fischer.

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Fischer, B., Wood, E. A decade of extreme oscillations in opioid control and availability: implications for public health in a Canadian setting. J Public Health Pol 41, 214–220 (2020). https://doi.org/10.1057/s41271-019-00214-0

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