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dc.contributor.authorPapadomanolakis-Pakis, Nicholasen
dc.date.accessioned2019-09-27T21:33:11Z
dc.date.available2019-09-27T21:33:11Z
dc.identifier.urihttp://hdl.handle.net/1974/26626
dc.description.abstractBackground: When measured in milligrams of morphine equivalents (MME) dispensed, Canada has the second highest rate of opioid prescribing in the world. Prescription opioids have been associated with adverse health outcomes, including opioid use disorder (OUD). This study will help to understand how patterns of initial prescription opioid use affect the risk of being treated for OUD. Objectives: To examine population-level patterns of opioid prescribing among previously opioid naïve individuals who initiated prescription opioid treatment for non-cancer pain, and to determine whether a dose-response relationship exists between average daily dose (in MME) at initiation and time to treated OUD. Methods: We conducted a population-based cohort study among opioid naïve individuals dispensed opioids for non-cancer pain between 2013 and 2016 in Ontario, Canada. The primary exposure was average daily dose (MME) at initiation of opioid therapy. Secondary exposures included opioid formulation type and total days’ supply. The outcome of interest was treated OUD. Individuals were followed for a maximum of 57 months (to March 31, 2018). We performed Kaplan-Meier survival and multivariable Cox regression to examine factors associated with risk of treated OUD. Results: 1,607,659 opioid-naïve individuals initiated a prescription opioid within the study period. The median age of individuals at initiation was 47 years (IQR 30-61), 52% were female and 88% lived in an urban community setting. The incidence rate of treated OUD within the study period was 86 cases per 100,000 person-years. Compared to an average daily dose of <20 MME at initiation, higher average daily doses were associated with greater hazard of treated OUD, 20-50 MME (HR 1.11, 95% CI: 1.02, 1.21), >50-90 MME (HR 1.29, 95% CI: 1.16, 1.44), >90-150 MME (HR 1.29, 95% CI: 1.06, 1.56), >150-200 MME (HR 2.49, 95% CI: 1.54, 4.03) and >200 MME (HR 4.15, 95% CI: 2.89, 5.97). Conclusions: Certain demographic, clinical and opioid prescription characteristics at initiation are associated with shorter times to treated OUD. Results suggest a dose-response relationship between average daily dose and time to treated OUD. This study highlights the importance of adhering to clinical practice guidelines when weighing the risks and benefits of prescription opioid initiation.en
dc.language.isoengen
dc.relation.ispartofseriesCanadian thesesen
dc.rightsQueen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canadaen
dc.rightsProQuest PhD and Master's Theses International Dissemination Agreementen
dc.rightsIntellectual Property Guidelines at Queen's Universityen
dc.rightsCopying and Preserving Your Thesisen
dc.rightsThis publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.en
dc.subjectOpioidsen
dc.subjectPublic Healthen
dc.subjectEpidemiologyen
dc.subjectHealthcareen
dc.subjectAddictionen
dc.titleInitiation of Prescription Opioids for Non-Cancer Pain and Risk of Treated Opioid Use Disorder: a Population-Based Studyen
dc.typethesisen
dc.description.degreeM.Sc.en
dc.contributor.supervisorMoore, Kieranen
dc.contributor.supervisorPeng, Yingwei Paulen
dc.contributor.departmentPublic Health Sciencesen
dc.embargo.termsPlease restrict this thesis as the manuscript has not yet been submitted for publication.en
dc.embargo.liftdate2021-02-19
dc.degree.grantorQueen's University at Kingstonen


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