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Patterns of opioid use (codeine, morphine or meperidine) in the Canadian population over time: analysis of the Longitudinal National Population Health Survey 1994–2011
  1. Mayilee Canizares1,
  2. J Denise Power1,
  3. Y Raja Rampersaud1,
  4. Elizabeth M Badley2
  1. 1 Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
  2. 2 Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Mayilee Canizares; mayilee.canizares{at}


Objective This study aimed to investigate cohort effects in selected opioids use and determine whether cohort differences were associated with changes in risk factors for use over time.

Design This study presents secondary analyses of a longitudinal survey panel of the general population that collected data biannually.

Setting Data from the Canadian Longitudinal National Population Health Survey 1994–2011.

Population This study included 12 542 participants from the following birth cohorts: post-World War I (born 1915–1924), pre-World War II (born 1925–1934), World War II (born 1935–1944), Older Baby Boom (born 1945–1954), Younger Baby Boom (born 1955–1964), Older Generation X (born 1965–1974) and Younger Generation X (born 1975–1984).

Main outcome Responses to a single question asking about the use of codeine, morphine or meperidine in the past month (yes/no) were examined.

Results Over and above age and period effects, there were significant cohort differences in selected opioids use: each succeeding recent cohort had greater use than their predecessors (eg, Gen Xers had greater use than younger baby boomers). Selected opioids use increased significantly from 1994 to 2002, plateauing between 2002 and 2006 and then declining until 2011. After accounting for cohort and period effects, there was a decline in use of these opioids with increasing age. Although pain was significantly associated with greater selected opioids use (OR=3.63, 95% CI 3.39 to 3.94), pain did not explain cohort differences. Cohort and period effects were no longer significant after adjusting for the number of chronic conditions. Cohort differences in selected opioids use mirrored cohort differences in multimorbidity. Use of these opioids was significantly associated with taking antidepressants or tranquillisers (OR=2.52, 95% CI 2.27 to 2.81 and OR=1.60, 95% CI 1.46 to 1.75, respectively).

Conclusions The findings underscore the need to consider multimorbidity including possible psychological disorders and associated medications when prescribing opioids (codeine, morphine, meperidine), particularly for recent birth cohorts. Continued efforts to monitor prescription patterns and develop specific opioid use guidelines for multimorbidity appear warranted.

  • opioid use
  • age-period-cohort
  • multimorbidity
  • antidepressants

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  • Contributors MC was the lead author on this paper. Her contributions included study design, statistical analysis and drafting of the manuscript. JDP and YRR contributed to the design of the study, interpretation of results and critically revised the manuscript. EMB provided guidance on the study design, analysis and structure of the manuscript. All authors read and approved the final manuscript and are accountable for all aspects of the study.

  • Funding This study was partially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no role in study design, analysis or interpretation of data, writing of the manuscript or the decision to submit it for publication.

  • Disclaimer Access to the data was through the Statistics Canada Research Data Centres (RDC) Program, which was approved by the Social Sciences and Humanities Research Council of Canada. RDCs are operated under the provisions of the Statistics Act in accordance with all the confidentiality rules and are accessible only to researchers with approved projects. The findings and conclusions of this paper are those of the authors and do not necessarily represent the official position of Statistics Canada.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data may be obtained from a third party and are not publicly available.

  • Patient consent for publication Not required.