New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years.

OBJECTIVES: Describe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec's public drug insurance plan (QPDIP) for the fiscal years 2006/2007-2019/2020. DESIGN AND SETTING: A retrospective observational study was conducted using data collected between 2006/2007 and 2019/2020 within the Quebec Integrated Chronic Disease Surveillance System, a linkage administrative data. PARTICIPANTS: A cohort of opioid naïve adults and new opioid users was created for each study year (median number=2 263 380 and 168 183, respectively, over study period). INTERVENTION: No. MAIN OUTCOME MEASURE AND ANALYSES: A new opioid prescription was defined as the first opioid prescription claimed by an opioid naïve adult during a given fiscal year. The annual incidence proportion for each year was then calculated and standardised for age. A hierarchical algorithm was built to identify the most likely clinical indication for this prescription. Descriptive and trend analyses were performed. RESULTS: There was a 1.7% decrease of age-standardised annual incidence proportion during the study period, from 7.5% in 2006/2007 to 5.8% in 2019/2020. The decrease was highest after 2016/2017, reaching 5.5% annual percentage change. Median daily dose and days' supply decreased from 27 to 25 morphine milligram equivalent/day and from 5 to 4 days between 2006/2007 and 2019/2020, respectively. Between 2006/2007 and 2019/2020, these prescriptions' most likely clinical indications increased for cancer pain from 34% to 48%, for surgical pain from 31% to 36% and for dental pain from 9% to 11%. Inversely, the musculoskeletal pain decreased from 13% to 2%. There was good consistency between the clinical indications identified by the algorithm and prescriber's specialty or user's characteristics. CONCLUSIONS: New opioid prescription claims (incidence, dose and days' supply) decreased slightly over the last 14 years among QPDIP enrollees, especially after 2016/2017. Non-surgical and non-cancer pain became less common as their clinical indication.

Efficacy of a Web-Based Tailored Intervention to Reduce Cannabis Use Among Young People Attending Adult Education Centers in Quebec.

BACKGROUND: Cannabis use is common among young adults. Web-based interventions are an increasingly popular way to reach this population. The aim of this study was to evaluate the efficacy of a Web-based tailored intervention, developed on theoretical and empirical grounds, to reduce cannabis use among young people by promoting a more positive intention to abstain. METHODS: An experimental design was employed to evaluate the efficacy of the intervention in reducing cannabis use (primary outcome) by bolstering intention (secondary outcome) to abstain from use. Participants were randomly assigned either to an experimental group that received the Web-based tailored intervention or to a control group that did not. RESULTS: Of 588 young adults (18-24 years of age) recruited, 295 were randomly assigned to the experimental group and 293 to the control group. At baseline, 343 reported using cannabis at least once in the past year. An intention-to-treat analysis showed that, at postintervention, a higher proportion of participants in the experimental group had reduced their cannabis use compared with the control group [10.8% vs. 5.1%, χ2(2) = 9.89, p = 0.007]. A mixed model for repeated measures revealed a statistically significant difference in terms of change in intention to abstain from cannabis use in the coming month [Group × Time interaction, F(1,474) = 8.03, p = 0.005]: intention increased for the experimental group (5.07 ± 2.07 to 5.45 ± 1.88; p < 0.001), but stayed stable for the control group (5.32 ± 2.03 to 5.36 ± 1.99; p = 0.779). CONCLUSION: This study shows that the intervention can be efficacious in reducing cannabis use among young people attending adult education centers.

Impact of a moderate-intensity walking program on cardiometabolic risk markers in overweight to obese women: is there any influence of menopause?

OBJECTIVE: The aim of this study was to examine the effect of brisk walking on cardiometabolic risk profile and on the gene expression (ie, messenger RNA [mRNA] levels) of inflammatory and thrombotic markers in abdominal and femoral subcutaneous adipose tissues (SATs) among sedentary overweight to obese women with different menopause statuses. METHODS: Sixteen late premenopausal (mean [SD] age, 49 [3] y; mean [SD] body mass index, 31.9 [3.0] kg/m) and 14 early postmenopausal (53 [2] y; 30.8 [1.9] kg/m) women were involved in a 16-week walking program (three sessions of 45 min/wk at 60% of heart rate reserve). Glucose-insulin homeostasis, lipid-lipoprotein profile, and inflammatory (tumor necrosis factor-α, interleukin-6 [IL-6], and adiponectin) and thrombotic (plasminogen activator inhibitor-1) SAT mRNA and plasma levels were measured before and after the intervention. RESULTS: Glucose area under the curve was reduced in all participants (P = 0.03) after the walking program. Increases in plasma tumor necrosis factor-α were observed in both groups (P = 0.001), whereas increases in plasminogen activator inhibitor-1 levels were found in postmenopausal women only (P = 0.014). However, plasma IL-6 and adiponectin levels remained unchanged after the intervention (0.07 < P < 0.98). Although femoral SAT adiponectin mRNA levels decreased in postmenopausal women only (P = 0.008), abdominal SAT IL-6 mRNA levels were reduced in both groups (P = 0.01). CONCLUSIONS: Taken together, our results show that, despite a reduced abdominal SAT IL-6 expression, brisk walking does not seem to exert a favorable impact on the cardiometabolic risk profile of overweight to obese women, irrespective of their menopause status.

Impact of walking on adipose tissue lipoprotein lipase activity and expression in pre- and postmenopausal women.

OBJECTIVE: The aim of this study was to examine regional variation in adipose tissue lipoprotein lipase (AT-LPL) activity and expression in pre-and postmenopausal women, before and after training, once differences in chronological age or obesity degree are taken into account. METHODS: Sixteen late pre- and 14 early postmenopausal (49 +/- 2 vs. 52 +/- 2 years; p < 0.001) moderately obese women (body mass index 29-35 kg/m(2)) were subjected to a 16-week walking program (3 sessions/week of 45 min at 60% heart rate reserve). Abdominal and femoral AT-LPL activity and expression, fasting lipid-lipoprotein profile, body composition, and cardiorespiratory fitness (CRF) were measured before and after our intervention. Statistical analyses were performed using covariance analysis for age differences. RESULTS: AT-LPL activity and expression, lipid-lipoprotein metabolism, body fatness, and CRF were similar at baseline, irrespective of the group considered. Slight reductions in plasma cholesterol and high-density lipoprotein (HDL) cholesterol levels, fat mass and waist girth reductions, CRF increases as well as femoral AT-LPL activity and expression decreases after our intervention were comparable, regardless of menopausal status (0.0001 < p < 0.05). CONCLUSIONS: Lipid storage is decreased in the femoral depot after walking, regardless of menopausal status. Reduction in AT-LPL activity or expression does not lead to a more deleterious lipid-lipoprotein profile, despite the modest decrease noted in HDL cholesterol concentrations.