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Other Psychoactive Pharmaceuticals

5.1 Medical Use and Dispensing

General Population

  • There are no publicly available estimates of prescription stimulant or prescription sedative/tranquilizer use for Ontario adults based on representative surveys.
  • Approximately 279,000 benzodiazepine prescriptions/month were dispensed to Ontario public drug plan beneficiaries 2007-13, based on data from the Ontario Public Drug Benefit Database.52 Approximately 2.3-2.5 million people used the Ontario Public Drug Benefit each year between 2007-08 and 2012-13.89
  • There was a 4.2% annual decrease in the volume of benzodiazepine prescriptions in Ontario (adjusted for inflation and age) between 2007-08 and 2012-13; in Canada, the annual decrease was 2.9% (IMS Brogan database of retail pharmacy dispensing).90 Similarly, between 2002 and 2013, there was a decrease in benzodiazepine dispensing among older Ontario adults (66 years and older) living in the community (15.6% to 10.6%) and in long-term care facilities (30.8% to 17.5%), based on data from the Ontario Public Drug Benefit Database.91
  • Approximately 14,000 stimulant prescriptions were dispensed/month to Ontario public drug plan beneficiaries between 2007 and 2013, based on data from the Ontario Public Drug Benefit Database.52
  • There was a 4.2% annual increase in the volume of ADHD drug prescriptions in Ontario (adjusted for inflation and age) between 2007-08 and 2012-13; in Canada, the annual increase was 7.8% (IMS Brogan database of retail pharmacy dispensing).90

Youth and Young Adults

  • There are no publicly available estimates of prescription stimulant or sedative/tranquilizer use for Ontario youth and young adults based on population-based surveys or dispensing data.

5.2 Non-medical and Illicit Use

General Population

  • There are no publicly available estimates of non-medical prescription stimulant or sedative/tranquilizer use for Ontario adults based on surveys representative of the general population.

Youth and Young Adults

  • In 2015, 2.1% of Ontario students (grades 7-12) reported (past-year) non-medical use of prescription stimulants (e.g., drugs to treat ADHD), an increase from 1.0% in 2007. Non-medical sedative/tranquilizer use was reported by 2.1% in 2015, according to the OSDUHS (n= 10,426).3
  • In 2008-09, 3.0% of students (grade 7-12) reported (past-year) use of prescription stimulants (e.g., ADHD medication, diet pills, stay-awake pills) to get high, based on an Ontario sub-sample from the national Youth Smoking Survey (n=44,344). Non-medical sedative/tranquilizer (e.g., Valium) use was reported by 1.8%.92
  • 2.0% of Ontario postsecondary students took prescription sedatives not prescribed to them (past 30 days), 3.7% took prescription stimulants and 3.0% took antidepressants, according to the 2013 NCHA Canadian survey (Ontario sub-sample n=16,123).6
  • Reported lifetime use rates were 3.8% for sedatives (e.g., downers, ludes) among Ontario postsecondary students, with 1.3% reporting  past-month use, according to the 2013 NCHA Canadian survey (Ontario sub-sample n=16,123).6

Special populations

Indigenous Populations

  • 3.8% of a sample of adults in Ontario First Nations Communities used sedatives without a prescription in the past year, as per the 2008-10 Regional Health Survey (n=1,500) representative of Ontario First Nation adults living on reserve.8,9
  • In non-reserve contexts, 10% of a sample of (n=554) First Nations adults (aged 18+) in Hamilton, Ontario, reported sedative/downer (e.g., Valium) use within the last year according to a (2009-10) respondent-driven sample.38

Racialized Populations

  • There are no publicly available provincial data on non-medical use of other psychoactive pharmaceuticals among racialized populations.

Homeless and Street-Involved Populations

  • 3% of homeless adults surveyed in Toronto reported barbiturate use (past two years) according to a stratified random sample (n=1,191) in 2004-05.12 Among a random sample of (n=368) Toronto-based homeless adults, 16% used sedatives, hypnotics or tranquilizers and 6% used downers regularly (+3 times/week) in the past year (2006-07).11
  • Among 'street-entrenched' drug-using adults (aged 19+) sampled in Toronto, 11% used Ritalin and 32% used benzodiazepines (past-year) (2012-13). Among 'street-involved' youth (aged 15-24) who use drugs, 12% used benzodiazepines (past-year) (2012-13 Health Canada High Risk Populations study).13
  • 18% of a sample of Toronto-based young homeless males who used substances and 29% of females used benzodiazepines in the past 6 months while 4% of both males and females used barbiturates among a convenience sample of (n=100) homeless youth (16-24 years) who use substances surveyed in Toronto (Drugs, Homelessness and Health survey, 2008-09).14

Pregnant and Parenting Women

  • There are no publicly-available provincial data on women's non-medical use of other psychoactive pharmaceuticals during pregnancy.

Injection Drug Users

Recreational Drug Users

  • 18% of 'recreational drug users' reported (past year) Ritalin/Dexedrine use among people recruited from event-specific sites such as raves or permanent nightclubs (2012-13 Health Canada High Risk Populations study).13
  • 3% of a sample of drug-using youth involved in party scenes in Toronto used Ritalin/Dexedrine (past 6 months) (Toronto Youth Drug online survey, 2014).13

5.3 Risks and Harms

Improper and Anomalous Prescribing

  • Between 2007 and 2011, 0.4% of publicly-funded benzodiazepine prescriptions in Ontario were dispensed within 7 days of another large benzodiazepine prescription by a different physician/pharmacy. The prevalence of potentially inappropriate benzodiazepine prescriptions decreased by 50.0% (to 0.2%) following enactment of narcotic-related legislation (2011) and a prescription monitoring system (2012), based on data from the Ontario Public Drug Database.52
  • Potential double prescriptions for bupropion (an antidepressant prone to misuse) increased from <0.05% to 0.47% of (publicly-funded) prescriptions between 2000 and 2013 and were more common than other antidepressants not prone to abuse, in a population-based study of Ontarians (aged <65) who received prescriptions under Ontario's public drug plan.93

Pharmaceuticals and Driving

  • Benzodiazepines and antidepressants were the most common drugs after cannabis found by toxicological testing of drivers involved in fatal MVCs in Ontario, among (n=229) samples submitted for testing 2011-12; drugs were detected in 44% of cases and benzodiazepines and antidepressants were each detected in 17% of those.19

Morbidity and Mortality

5.4 Interventions

Treatment

  • Benzodiazepines were reported as a problem substance upon admission by 3.6% (3,581 admissions) of patients presenting to Ontario publicly-funded substance abuse treatment in 2012-13; 0.3% (282 admissions) reported barbiturates as a problem substance at admission (DATIS).25