Increased opioid-related mortality in the US and Canada

We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013.

We identified 17 determinants of opioid-relatedmortality andmortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population,making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult.

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