Journal of Epidemiology and Community Health
Volume 68, Issue 11, 2014, Pages 1057-1063

Risk of overdose and death following codeine prescription among immigrants (Article)

Ray J.G.* , Hollands S. , Gomes T. , Urquia M.L. , Macdonald E.M. , Li P. , Mamdani M.M. , Juurlink D.N.
  • a Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
  • b Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
  • c Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
  • d Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
  • e Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
  • f Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
  • g Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
  • h Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada

Abstract

Background: Immigrants may be at a higher risk of adverse drug reactions, in that poor language proficiency reduces individuals understanding of drug label instructions. Additionally, there are reports of severe or fatal toxicity due to CYP2D6 ultrarapid hepatic metabolism of codeine to morphine among some ethnic groups, especially those from Eastern Africa. Methods: Between 2002 and 2012 we conducted a population-based cohort study among residents of Ontario, Canada. We used administrative health databases that linked immigrants and Canadian-born individuals to both prescription medication use and emergency department visits and hospital admissions. The primary composite outcome was the risk of drug overdose or all-cause mortality within 30 days of codeine prescription, comparing patients from various world regions to Canadian-born individuals. A secondary analysis stratified by codeine dose and ability to speak English and/or French. Results: There were 553 504 individuals exclusively prescribed codeine. Relative to an incidence rate of 57.1/100 000 person-days among Canadian-born codeine recipients, those who migrated from various world regions were at a lower risk of drug overdose or death. For example, Eastern Africans had an adjusted HR of 0.60 (95% CI 0.31 to 1.17) on controlling for potential confounders such as age, sex, income and physician visits. Patients unable to speak English or French who were prescribed codeine were at a lower risk of the composite outcome relative to those proficient in either language (adjusted HR 0.63, 95% CI 0.54 to 0.74). Interpretation: Overdose and death following the institution of codeine therapy are not more commonly observed among immigrants from world regions with a high prevalence of ultrarapid CYP2D6 status relative to those born in Canada. Lower proficiency in English or French also did not appear to heighten the risk.

Author Keywords

[No Keywords available]

Index Keywords

genetics Communication Barriers immigrant proportional hazards model Registries Proportional Hazards Models metabolism health risk register human epidemiology communication disorder middle aged Cohort Studies statistics and numerical data ethnic group health status Aged oral drug administration Administration, Oral cytochrome P450 2D6 nonsteroid antiinflammatory agent language ethnology Cytochrome P-450 CYP2D6 resident population drug overdose prescription drug Prescription Drugs toxicity Codeine Anti-Inflammatory Agents, Non-Steroidal Humans migrant male Canada Emigrants and Immigrants female Southeast Asia Africa Incidence disease prevalence Ontario mortality emergency health service cohort analysis Emergency Service, Hospital Ontario [Canada] cause of death Asia, Southeastern Africa, Eastern
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84911441841&doi=10.1136%2fjech-2014-204489&partnerID=40&md5=70d5765353de6579555dd4b005ec9867
DOI: 10.1136/jech-2014-204489
ISSN: 0143005X
Cited by: 1
Original Language: English