Opioid Prescribing Patterns for Treatment of Acute and Chronic Pain in Rural and Urban British Columbia

  • Author / Creator
    Harder, Kari A.
  • Throughout Canada there has been an increase in both fatal and non-fatal opioid related overdoses, with British Columbia having some of the highest rates. In response to this increase, the Provincial Health Officer of British Columbia declared a public health emergency to mobilize resources to gather more robust data to better understand and respond to this increase. The current evidence has shown that there are differences between urban and rural health regions in British Columbia, which suggests that there may be unique drivers to fatal and non-fatal opioid related overdoses. The purpose of this research was to explore rural and urban differences in acute and chronic non-cancer pain, opioid prescription characteristics, the use of multiple prescribers and the associated risk of fatal and non-fatal overdoses. A systematic review examined the evidence for differences in opioid prescription characteristics between rural and urban areas. Two multivariate Cox regression analyses were conducted utilizing the British Columbia Provincial Overdose Cohort (Version 1) to examine rural and urban difference in chronic pain, opioid prescription characteristics and multiple prescribers, and risk of overdose. Chi-square tests with Cramer’s V were utilized to examine opioid prescription dispensation characteristics between rural and urban residents. Chronic pain significantly increased the risk of experiencing an overdose; however, when prescription for opioids were included in the analysis, there was no longer an increase in risk for experiencing a fatal or non-fatal overdose associated with chronic pain. The risk for experiencing a fatal or non-fatal overdose when individuals had a prescription for opioids depended upon a diagnosed substance use disorder. Prescription opioids mitigated the risk of a fatal or non-fatal overdose for those individuals who had a diagnosis of a substance use disorder, and for those individuals who did not have a substance use disorder diagnosis it increased the risk. When examining geographic differences, opioid prescriptions and related characteristics there were minimal variation, with the exception of a longer duration of opioid prescriptions for acute pain for individuals who lived in rural areas which was consistent to the findings of the systematic review. In addition, the overdose risk related to opioid prescriptions and their characteristics did not vary based on rural-urban geography. The use of multiple prescribers increased people’s risk of overdose, however for individuals living in a rural area the use of multiple prescribers mitigated the risk of experiencing an overdose. The presented research highlights the complexity in understanding the risk of overdose. The findings from these studies highlight that reducing access to opioid prescriptions for the entire population may have mixed results; with those who do not have a substance use disorder diagnosis potentially benefiting from reduced access to opioid prescriptions, but potentially harming those individuals with a substance use disorder diagnosis. In the current study, the geographical differences in the rate of overdose were not explained by the differences in opioid prescribing practices; thus, further study is needed to understand the potential factors that will help explain the differences in overdose rates between rural and urban areas.

  • Subjects / Keywords
  • Graduation date
    Spring 2022
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.