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Nearly 1,000 people died of opioid overdose deaths in Alberta in 2020. That’s why researchers with the O’Brien Institute for Public Health at the Cumming School of Medicine (CSM) — aware of the continuing toll of this emergency — are working to better understand how the problem propagates in the first place.

Safe prescribing in emergency rooms

A heart attack, a broken bone or a kidney stone — emergency departments are a black hole for acute pain and possible opioid prescribing, says Dr. Grant Innes, MD, who will study the role prescribing in these settings plays in opioid addiction.

“This has become a huge public health crisis, when you look at the data and the number of overdose-related deaths, it's taken a really dramatic upward trajectory. There are a large number of preventable deaths in a relatively young population,” he says.

Emergency departments are an important area to study, as many people visit with acute pain, which makes opioid prescribing necessary, Innes says.

Innes is working to identify characteristics of patients who should, and patients who should not, receive opioid prescriptions.

“That way we can give physicians guidance as to when it is appropriate to use an opioid acutely,” he says.

The research team, which received close to $150,000 from the Canadian Institutes for Health Research (CIHR), will look at a sample of emergency department patients discharged from Alberta's adult hospitals over a 10-year period, and determine from the prescription information database which patients received an opioid prescription.

Researchers will compare patients who received opioids to a matched population who didn’t, then look at data in the following years for repeat hospitalizations, opioid use disorder diagnoses, and future opioid prescriptions to identify patients who developed opioid dependency or long-term opioid use.

Safe prescribing for people with cancer

Studying chronic opioid use among cancer patients is research that needs to happen now, as dual epidemics occur in North America, says Dr. Winson Cheung, MD.

“I think before the current pandemic, the use of opioids was labelled as the epidemic facing Canada and North America. And I would say because of the pandemic, the opioid part has been sort of forgotten,” says Cheung.

Studying opioid use in people who have been diagnosed with cancer is crucial, as many use opioids for pain management, and with people working from home due to COVID-19, attending virtual visits, the dynamic can lend itself to the possibility of higher risk of misuse or inappropriate use, Cheung says.

Often, people diagnosed with cancer have multiple physicians, which can also potentially increase the risk of opioid misuse, Cheung says. 

He says it's important to generate knowledge that will inform best practices for safe opioid prescribing in cancer patients — the solution is not to avoid prescribing opioids, but to ensure they are prescribed appropriately and are not causing additional harm.

Using Alberta databases, and a $500,000 grant from the CIHR, researchers will look at patient, physician, and hospital factors to see whether there are certain groups who are more at risk of misuse. Cheung’s team will also conduct focus groups with patients and physicians. 

“We will look at age, sex, what cancer the person has, what chemotherapy did they get, when was their surgery? All these factors influence the risk profile, either increasing or decreasing the patient's affinity for misuse,” he says.