Review of Coroner Inquest Recommendations into Opioid Prescribing Practices in Ontario: Ongoing Health Policy Gaps.

The rate at which opioids are being prescribed and the safety of prescription opioid use are serious and ongoing problems for individuals, communities and health systems across Canada. In 2011, a coroner's inquest was held in Brockville, Ontario, Canada, to examine the issue of prescription opioid diversion and abuse. Following the inquest, the jury provided 48 recommendations pertaining to prescribing and monitoring of opioids. The ensuing discussion highlights health policy gaps that remain to be addressed seven years after the inquest, in educational resource-sharing, high-dose prescribing, development and use of abuse-resistant formulations and coordination and monitoring of policy interventions.

A longitudinal analysis of temporal and spatial incidence of neonatal abstinence syndrome in Ontario: 2003-2016.

OBJECTIVE: This study describes the incidence of neonatal abstinence syndrome (NAS) in Ontario, Canada by year and health region from 2003 to 2016. DESIGN: The incidence of NAS diagnoses per 1,000 live births was calculated for the 36 local public health agency regions in Ontario from 2003 to 2016 using retrospective hospital admissions data. Infants with a diagnosis of NAS were identified using ICD-10 code P961. Local public health agency level data were aggregated and analyzed by geographic region and by Statistics Canada 2015 Peer Groups. RESULTS: The incidence of NAS in Ontario increased from 0.99 per 1,000 live births in 2003 to 5.94 per 1,000 live births in 2016. There were major differences in NAS incidence by geography, North Western Ontario had the greatest incidence across all years. Health regions with a rural and population center mix or mostly rural population had greater incidence rate of NAS compared to health regions with high density population centers. CONCLUSIONS: The incidence of NAS has dramatically increased across Ontario in the last decade. Actions should be taken to combat the continued increase in NAS rates, especially in health regions with disproportionately high incidence of NAS.

Investigation of biotransformation, sorption, and desorption of multiple chemical contaminants in pilot-scale drinking water biofilters.

The evolving demands of drinking water treatment necessitate processes capable of removing a diverse suite of contaminants. Biofiltration can employ biotransformation and sorption to remove various classes of chemicals from water. Here, pilot-scale virgin anthracite-sand and previously used biological activated carbon (BAC)-sand dual media filters were operated for ∼250 days to assess removals of 0.4 mg/L ammonia as nitrogen, 50-140 µg/L manganese, and ∼100 ng/L each of trace organic compounds (TOrCs) spiked into pre-ozonated Colorado River water. Anthracite achieved complete nitrification within 200 days and started removing ibuprofen at 85 days. Limited manganese (10%) removal occurred. In contrast, BAC completely nitrified ammonia within 113 days, removed all manganese at 43 days, and exhibited steady state removal of most TOrCs by 140 days. However, during the first 140 days, removal of caffeine, DEET, gemfibrozil, naproxen, and trimethoprim decreased, suggesting a shift from sorption to biotransformation. Acetaminophen and sulfamethoxazole were removed at consistent levels, with complete removal of acetaminophen achieved throughout the study; ibuprofen removal increased with time. When subjected to elevated (1 µg/L) concentrations of TOrCs, BAC removed larger masses of chemicals; with a subsequent decrease and ultimate cease in the TOrCs spike, caffeine, DEET, gemfibrozil, and trimethoprim notably desorbed. By the end of operation, anthracite and BAC exhibited equivalent quantities of biomass measured as adenosine triphosphate, but BAC harbored greater microbial diversity (examined with 16S rRNA sequencing). Improved insight was gained regarding concurrent biotransformation, sorption, and desorption of multiple organic and inorganic contaminants in pilot-scale drinking water biofilters.

A public health outbreak management framework applied to surges in opioid overdoses.

Over the past decade, Canada and the United States have been facing an epidemic of harms from prescription opioids. More recently, opioid-naïve individuals have been exposed to illicit opioids through adulterated combination products. This has resulted in sudden surges of opioid-related mortality. A proactive public health solution is needed to prevent further death. We propose examining these surges in opioid overdoses as outbreaks and investigating them in a similar way to an outbreak of an infectious disease. An epidemiologic investigation model for opioid overdose outbreaks, that could be modified by other public health agencies, is discussed.