{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:54:11Z","timestamp":1790380451849,"version":"4.1.0"},"reference-count":62,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,5,20]],"date-time":"2013-05-20T00:00:00Z","timestamp":1369008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>This paper aims to identify possible system\u2010level factors contributing to the marked differences in the levels of non\u2010medical prescription opioid use (<jats:styled-content style=\"fixed-case\">NMPOU<\/jats:styled-content>) and prescription opioid (<jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>)\u2010related harms in North America (i.e. the <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>nited <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>tates and <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>anada) compared to other global regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Scientific literature and information related to relevant areas of health systems, policy and practice were reviewed and integrated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified several but different factors contributing to the observed differences. First, North American health\u2010care systems consume substantially more <jats:styled-content style=\"fixed-case\">Pos<\/jats:styled-content>\u2014even when compared to other high\u2010income countries\u2014than any other global region, with dispensing levels associated strongly with levels of <jats:styled-content style=\"fixed-case\">NMPOU<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>\u2010related harms. Secondly, North American health\u2010care systems, compared to other systems, appear to have lesser regulatory access restrictions for, and rely more upon, community\u2010based dispensing mechanisms of <jats:styled-content style=\"fixed-case\">POs<\/jats:styled-content>, facilitating higher dissemination level and availability (e.g. through diversion) of <jats:styled-content style=\"fixed-case\">POs<\/jats:styled-content> implicated in <jats:styled-content style=\"fixed-case\">NMPOU<\/jats:styled-content> and harms. Thirdly, we note that the generally high levels of psychotrophic drug use, dynamics of medical\u2013professional culture (including patient expectations for \u2018effective treatment\u2019), as well as the more pronounced \u2018for\u2010profit\u2019 orientation of key elements of health care (including pharmaceutical advertising), may have boosted the <jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>\u2010related problems observed in North America.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Differences in the organization of health systems, prescription practices, dispensing and medical cultures and patient expectations appear to contribute to the observed inter\u2010regional differences in non\u2010medical prescription opioid use and prescription opioid\u2010related harms, although consistent evidence and causal analyses are limited. Further comparative examination of these and other potential drivers is needed, and also for evidence\u2010based intervention and policy development.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.12224","type":"journal-article","created":{"date-parts":[[2013,5,20]],"date-time":"2013-05-20T16:50:12Z","timestamp":1369068612000},"page":"177-181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":132,"title":["Non\u2010medical use of prescription opioids and prescription opioid\u2010related harms: why so markedly higher in <scp>N<\/scp>orth <scp>A<\/scp>merica compared to the rest of the world?"],"prefix":"10.1111","volume":"109","author":[{"given":"Benedikt","family":"Fischer","sequence":"first","affiliation":[{"name":"Centre for Applied Research in Mental Health and Addictions (CARMHA) Faculty of Health Sciences Simon Fraser University  Vancouver Canada"},{"name":"Social and Epidemiological Research Department Centre for Addiction and Mental Health (CAMH)  Toronto Canada"},{"name":"Department of Psychiatry University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Keates","sequence":"additional","affiliation":[{"name":"VU University  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"B\u00fchringer","sequence":"additional","affiliation":[{"name":"Institute of Clinical Psychology and Psychotherapy Technische Universit\u00e4t  Dresden Germany"},{"name":"IFT Institut f\u00fcr Therapieforschung  M\u00fcnchen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Reimer","sequence":"additional","affiliation":[{"name":"Centre for Interdisciplinary Addiction Research University of Hamburg  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Rehm","sequence":"additional","affiliation":[{"name":"Social and Epidemiological Research Department Centre for Addiction and Mental Health (CAMH)  Toronto Canada"},{"name":"Department of Psychiatry University of Toronto  Toronto Canada"},{"name":"Institute of Clinical Psychology and Psychotherapy Technische Universit\u00e4t  Dresden Germany"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,5,20]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60007-5"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.18356\/e04aa9e2-en"},{"key":"e_1_2_3_4_1","volume-title":"Annual Report 2011: The State of the Drugs Problem in Europe","author":"European Monitoring Center on Drugs and Drug Abuse (EMCDDA)","year":"2011"},{"key":"e_1_2_3_5_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2010\/13\/401"},{"key":"e_1_2_3_6_1","unstructured":"Substance Abuse and Mental Health Services Administration (SAMHSA).State Estimates of Substance Use and Mental Disorders from the 2008\u20132009 National Surveys on Drug Use and Health. NSDUH Series H\u201040 HHS Publication no. (SMA) 11\u20104641.Rockville MD:SAMHSA;2011."},{"key":"e_1_2_3_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.12025"},{"key":"e_1_2_3_8_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060729"},{"key":"e_1_2_3_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/10550490600625624"},{"key":"e_1_2_3_10_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2012\/15\/ES191"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.369"},{"key":"e_1_2_3_12_1","first-page":"1487","article-title":"Vital signs: overdoses of prescription opioid pain relievers\u2014United States, 1999\u20132008","volume":"60","author":"Paulozzi L.","year":"2011","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_2_3_13_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090784"},{"key":"e_1_2_3_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1011512"},{"key":"e_1_2_3_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000337028"},{"key":"e_1_2_3_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2009.01982.x"},{"key":"e_1_2_3_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2008.01.269"},{"key":"e_1_2_3_18_1","first-page":"367","article-title":"Over\u2010the\u2010counter and prescription medicine misuse in Cape Town\u2014findings from specialist treatment centres","volume":"93","author":"Myers B.","year":"2003","journal-title":"S Afr Med J"},{"key":"e_1_2_3_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/10826081003692098"},{"key":"e_1_2_3_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2010.029611"},{"key":"e_1_2_3_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00414-008-0230-x"},{"key":"e_1_2_3_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2010.11.032"},{"key":"e_1_2_3_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2012.04.010"},{"key":"e_1_2_3_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.3.249"},{"key":"e_1_2_3_25_1","doi-asserted-by":"publisher","DOI":"10.1300\/J069v27n01_01"},{"key":"e_1_2_3_26_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2008\/11\/S63"},{"key":"e_1_2_3_27_1","volume-title":"Narcotic Drugs Technical Report: Estimated World Requirements for 2012\u2014Statistics for 2010","author":"International Narcotics Control Board (INCB)","year":"2012"},{"key":"e_1_2_3_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2011.03655.x"},{"key":"e_1_2_3_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2007.05296.x"},{"key":"e_1_2_3_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-011-1200-2"},{"key":"e_1_2_3_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp581"},{"key":"e_1_2_3_32_1","first-page":"507","article-title":"The influence of prescription monitoring programs on chronic pain management","volume":"12","author":"Wang J.","year":"2009","journal-title":"Pain Physician"},{"key":"e_1_2_3_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31816493fb"},{"key":"e_1_2_3_34_1","first-page":"45","article-title":"Increases in opioid prescriptions in Germany, 2000\u20132010","volume":"110","author":"Schubert I.","year":"2013","journal-title":"Deutsches \u00c4rzteblatt"},{"key":"e_1_2_3_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2190"},{"key":"e_1_2_3_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-21992-4_6"},{"key":"e_1_2_3_37_1","unstructured":"IalomiteanuA. AdlafE. M. HamiltonH. MannR. E.2011 CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults 1977\u20132011 (CAMH Research Document Series no. 35). Toronto: Centre for Addiction and Mental Health.2012. Available at:http:\/\/www.camh.ca\/en\/research\/news_and_publications\/Pages\/camh_monitor.aspx(accessed 4 February 2013) (Archived athttp:\/\/www.webcitation.org\/6EBgKMYHGon 4 February 2013)."},{"key":"e_1_2_3_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2010.03092.x"},{"key":"e_1_2_3_39_1","unstructured":"PedersonK.The British Columbia Coroners Service: a perspective on prescription opiates.2011. Available athttp:\/\/www.csam.org\/files\/Pederson_\u2010_BC_Coroners.pdf(accessed 4 February 2013) (Archived athttp:\/\/www.webcitation.org\/6EBgRziWqon 4 February 2013)."},{"key":"e_1_2_3_40_1","first-page":"10","article-title":"CDC grand rounds: prescription drug overdoses\u2014a U.S. epidemic","volume":"61","author":"Paulozzi L.","year":"2012","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_2_3_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2009.00603.x"},{"key":"e_1_2_3_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-8"},{"key":"e_1_2_3_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2008.10.008"},{"key":"e_1_2_3_44_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000268145.52345.55"},{"key":"e_1_2_3_45_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.059402"},{"key":"e_1_2_3_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp001"},{"key":"e_1_2_3_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2005.06.009"},{"key":"e_1_2_3_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdn419"},{"key":"e_1_2_3_49_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/654651"},{"key":"e_1_2_3_50_1","doi-asserted-by":"publisher","DOI":"10.18356\/94bbf1f4-en"},{"key":"e_1_2_3_51_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050141"},{"key":"e_1_2_3_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(02)00224-7"},{"key":"e_1_2_3_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02688204"},{"key":"e_1_2_3_54_1","doi-asserted-by":"publisher","DOI":"10.1186\/1753-2000-2-26"},{"key":"e_1_2_3_55_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1254"},{"key":"e_1_2_3_56_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp068113"},{"key":"e_1_2_3_57_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0030145"},{"key":"e_1_2_3_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(96)00257-2"},{"key":"e_1_2_3_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2003.12.017"},{"key":"e_1_2_3_60_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecam\/neh092"},{"key":"e_1_2_3_61_1","volume-title":"International Profiles of Health Care Systems, 2011","author":"The Commonwealth Fund","year":"2011"},{"key":"e_1_2_3_62_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2009.01.080102"},{"key":"e_1_2_3_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(89)90252-9"}],"container-title":["Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fadd.12224","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.12224","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T22:17:06Z","timestamp":1696371426000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/add.12224"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,20]]},"references-count":62,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014,2]]}},"alternative-id":["10.1111\/add.12224"],"URL":"https:\/\/doi.org\/10.1111\/add.12224","archive":["Portico"],"relation":{},"ISSN":["0965-2140","1360-0443"],"issn-type":[{"value":"0965-2140","type":"print"},{"value":"1360-0443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5,20]]},"assertion":[{"value":"2012-10-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-04-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-05-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}